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Uptick in black fungus cases: More focus on immunocompromised persons

18 Sep 2021

  • 10 cases identified so far in several areas
By Aazam Ameen Immunocompromised persons who have a reduced ability to fight infections and other diseases have been advised to be mindful of their surroundings and maintain good hygiene, following a recent uptick in cases of mucormycosis, commonly known as “black fungus”, The Sunday Morning learnt. Speaking to us, Ministry of Health Communications Director and Deputy Director General of Public Health Services (DDGPHS) Dr. Hemantha Herath explained that the group of moulds which cause mucormycosis, known as mucormycetes, is naturally present in the environment, and only those with weak immune systems are at risk of infection. “It is extremely rare for a healthy person to get this infection. Only immunocompromised groups are at risk,” he explained. Since the group of infection-causing moulds thrive in decaying organic material, including garbage, compost, animal waste, and other forms of organic waste, Dr. Herath advised immunocompromised persons to avoid such environments and maintain good hygiene. He further explained that in the event mucormycetes spores enter the body of such a person through orifices or skin lesions, the spores will continue to spread to other parts of the body and invade vital organs, resulting in death. When queried if mucormycosis is a communicable or contagious disease, Dr. Herath explained: “On rare occasions, if an immunocompromised mucormycosis patient comes into contact with another immunocompromised person who is not infected with mucormycosis, inhalation of spores exhaled by the patient may infect the patient’s contact. Due to the fact that only immunocompromised persons may be infected with mucormycosis, it cannot be categorised as a communicable or contagious disease.” In terms of mucormycosis infections in relation to Covid-19-infected persons or those recovering from Covid-19, Dr. Herath stated that severely immunocompromised people by default end up having severe Covid-19 infections. Therefore, such people are susceptible to mucormycosis infections as well, regardless of whether they have Covid-19 or not. Dr. Herath also explained that if the ongoing lockdown is lifted prematurely, there is a theoretical possibility that mucormycosis infection rates may also increase. “If the Covid-19 numbers are going up and more healthy people get infected, immunocompromised persons will also get infected, and out of them, it is possible to see a relatively high number of mucormycosis cases as well,” he explained. He also dismissed rumours that mucormycosis was introduced to Sri Lanka from India, as the country saw a large number of such infections in the recent past. “Maybe it came to Sri Lanka from India millions of years ago, but it definitely did not come to Sri Lanka because of the recent Indian epidemic. Mucormycosis cases were reported in Sri Lanka far before the Indian epidemic and even far before the Covid-19 pandemic,” he clarified. Medical Research Institute (MRI) Consultant Mycologist Dr. Primali Jayasekara revealed details with regard to the updated numbers on such infections in Sri Lanka at a press conference held last Wednesday (15). “Two cases of mucormycosis were detected among Covid-infected patients at the Ratnapura Hospital in June. Another two patients were reported from the Trincomalee Base Hospital in June, along with a single case in July. Two cases were reported from the National Hospital in August and September. Single infections have been identified at the Ratnapura, Kalubowila, and Karapitiya Teaching Hospitals so far in September,” she said. She also noted that all those infections were confirmed after samples were tested for both Covid-19 and mucormycosis. According to the US Centres for Disease Control and Prevention (CDC), the types of moulds which cause mucormycosis are of the Rhizopus, Mucor, Rhizomucor, Syncephalastrum, Cunninghamella bertholletiae, Apophysomyces, and Lichtheimia species. It also lists out four types of mucormycosis: (i) Rhinocerebral (sinus and brain) mucormycosis is an infection in the sinuses that can spread to the brain. This is most common in people with uncontrolled diabetes and in people who have had a kidney transplant (ii) Pulmonary (lung) mucormycosis is the most common type of mucormycosis in people with cancer and in people who have had an organ transplant or a stem cell transplant (iii) Gastrointestinal mucormycosis is more common among young children than adults. Premature and infants less than one month of age with low birth weight are at risk if they have had antibiotics, surgery, or medications that lower the body’s ability to fight germs and sickness (iv) Cutaneous (skin) mucormycosis occurs after the fungi enter the body through a break in the skin. This type of infection might occur after a burn, scrape, cut, surgery, or other types of skin trauma. This is the most common form of mucormycosis among people who do not have weakened immune systems Disseminated mucormycosis occurs when the infection spreads through the bloodstream to affect another part of the body. The infection most commonly affects the brain but can also affect other organs such as the spleen, heart, and skin.


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