Black Fungus Symptoms, Causes and Treatment

What is Black Fungus?

Black fungus generally refers to a severe fungal infection known as mucormycosis. The infection is caused by a family of molds named mucormycetes that are present in the environment, particularly in soil, rotting organic matter, and compost. 

Important Facts regarding Black Fungus (Mucormycosis):

• Etiologic agents: Mucormycetes fungi, particularly from genera such as Rhizopus, Mucor, and Lichtheimia.
• Appearance: Refers to as "black fungus" due to the black discoloration that may occur in infected tissues, particularly on the face or nasal cavity.
• Mode of Infection: Most often infects individuals who breathe in the fungal spores. It may also penetrate through wounds or skin trauma.

Types of Mucormycosis:

• Rhinocerebral (sinus and brain) – most frequently occurring form, particularly among diabetic or immunocompromised individuals.
• Pulmonary (lungs) – prevalent among cancer patients or organ transplant recipients.
• Gastrointestinal – typically occurs in young children.
• Cutaneous (skin) – follows skin injury or surgery.
• Disseminated – spreads via the blood and affects several organs.

Black Fungus Symptoms

Black fungus (mucormycosis) can have varying symptoms depending on where in the body the infection lies, but the most frequent and life-threatening is rhinocerebral mucormycosis (sinuses, brain, and face).

Following are the key symptoms based on the type of mucormycosis:

General Symptoms of Black Fungus (Rhinocerebral Mucormycosis):

• Swelling or pain in the face, one-sided
• Black or discolored nasal, mouth, or palate patches
• Nasal discharge or congestion, blackish
• Headache
• Fever
• Eye swelling, redness, or bulging of the eye
• Blurred or double vision
• Loss of vision
• Facial numbness or paralysis
• Toothache or loosening of teeth
• Difficulty chewing or opening the mouth
• Mental confusion or drowsiness (if brain is involved)

Pulmonary (Lung) Mucormycosis:

• Fever
• Cough
• Chest pain
• Shortness of breath
• Blood-tinged sputum

Cutaneous (Skin) Mucormycosis:

• Blisters, ulcers, or blackened skin
• Redness, swelling, and tenderness
• Localized pain or warmth at the site

Gastrointestinal Mucormycosis (Rare):

• Abdominal pain
• Nausea or vomiting
• Gastrointestinal bleeding
• Swelling in the abdomen

Disseminated Mucormycosis (Spreads in the body):

• Mental status changes
• Coma
• Multiple organ failure (in severe cases)

Black Fungus Treatment

Mucormycosis is an emergency condition, and treatment should be prompt and aggressive. Early diagnosis and treatment are better for survival.

Antifungal Medication

Treatment of choice is intravenous antifungal therapy:

Primary Antifungal Drugs:

• Liposomal Amphotericin B
• Most widely used and effective
• High doses (5–10 mg/kg/day) intravenously
• Posaconazole or Isavuconazole
• As alternatives or oral follow-up therapy after Amphotericin B
• Used also if Amphotericin B cannot be tolerated
• Duration: Therapy is usually continued for 4–6 weeks or longer, based on severity and response of the patient.

Surgical Debridement

• Such infected tissue must be urgently removed.

May include:

• Removal of dead tissue from sinuses, eyes, or brain
• In severe cases, removal of an eye (orbital exenteration) to prevent further spread
• This reduces the chance of spread of the fungus and increases the efficacy of antifungal therapy.

Control of Underlying Conditions

• Tight control of blood sugar in diabetic patients
• Discontinue or taper corticosteroids or immunosuppressive medications (with medical supervision)
• Enhance immunocompetence, if feasible (e.g., in patients with cancer or transplant recipients)

Supportive Care

• Oxygen therapy (if needed)
• Nutritional management
• Kidney and liver function monitoring during antifungal therapy (particularly with Amphotericin B)

Black Fungus Causes

Black fungus is caused by a family of molds known as mucormycetes, which are present naturally in the environment (soil, rotting leaves, compost, and animal manure). When these fungi infect the body of an immunocompromised individual, they produce a severe, frequently fatal infection named mucormycosis.

How It Enters the Body?

Inhalation of fungal spores (most common)

• Spores are inhaled into the sinuses or lungs by breathing.

Ingestion (rare)

• Food or water containing the contamination.

Skin exposure

• By cuts, burns, wounds, or operative wounds.

Black Fungus in Humans

Human black fungus is a term for an uncommon but life-threatening fungal infection known as mucormycosis, which results from contact with mucormycetes, a collection of molds that occur naturally in the environment.

Why It's Dangerous?

• Quickly advancing and possibly lethal if not treated promptly.
• Especially targets individuals with compromised immune systems.
• Can penetrate blood vessels, leading to cell death, resulting in the blackened appearance in infected areas.

How It Affects Humans

It usually infects:

• Sinuses
• Lungs
• Brain
• Eyes
• Skin
• Gastrointestinal tract (rare)

Black Fungus Disease

Black fungus disease, also referred to as mucormycosis, is a rare but serious fungal infection produced by molds termed as mucormycetes. It mainly attacks individuals with compromised immune systems, and if not treated immediately, can result in serious complications or even cause death.

What Causes Black Fungus Disease?

• Environmental fungal spores (soil, decaying materials, compost)

Enter the body via:

• Inhalation (most frequent)
• Wound on the skin
• Infected medical devices (e.g., humidifiers, oxygen tubing)

How to prevent black fungus?

Preventing black fungus (mucormycosis) is most critical for individuals with compromised immunity, including those recovering from COVID-19, diabetes, or those undergoing steroids or oxygen therapy.

Control Underlying Health Conditions

• Maintain blood sugar in check, particularly if diabetic.
• Monitor blood glucose frequently, even post-COVID-19 recovery.
• Avoid steroids, or restrict their use, unless absolutely essential and under medical guidance.
• If immunocompromised (e.g., cancer, transplant recipient), observe strict infection control measures.

Maintain Personal Hygiene

• Bathe every day and maintain skin, hair, and nails clean and dry.
• Wash face and hands often.
• Wash wounds well and cover with sterile dressings.

Maintain Clean Medical Equipment (Particularly in COVID Care)

• Use oxygen humidifiers with sterile water.
• Disinfect and clean nebulizers, masks, and oxygen tubes daily.
• ICU and ventilator equipment should be sanitized strenuously by hospitals.

Minimize High-Risk Environments

• Avoid dusty or moldy sites such as construction, old structures, and compost piles.

If you have to visit such sites:

• Wear N95 masks
• Wear gloves, shoes, long sleeves, and pants

Boost Immunity Naturally

• Eat a balanced and healthy diet that is full of vitamins and minerals.
• Rest well and take care of your stress.
• Don't smoke and drink.

Watch for Early Symptoms

Be aware of:

• Nasal congestion or black discharge
• Swelling or pain in the face, eyes, or nose
• Eye or vision issues
• Fever or headache that does not change

Black Fungus Diagnosis

Diagnosis of black fungus (mucormycosis) mandates immediate medical examination since prompt diagnosis is essential to avoid severe complications or death.

Step-by-Step Diagnosis Process

Clinical Evaluation

History check:

• Recent COVID-19 infection
• Diabetes, steroid use, immunosuppression

Symptom review:

• Facial swelling, black nasal discharge, eye pain, loss of vision, high fever persisting, chest pain, or wound infection

Physical Examination

• ENT inspection (nasal cavity, sinuses)
• Eye examination for swelling or visual impairment
• Oral cavity examination for black ulcers or lesions

Imaging Tests

• Used to check how extensive the infection has become.
• CT scan (of sinuses/chest/brain): To check for tissue damage, bone loss, or involvement of the lungs
• MRI scan: Is superior for brain or orbital (eye) involvement

Laboratory Tests

These are used to confirm the diagnosis of the fungus:

Nasal endoscopy with tissue biopsy:

• Sample from infected tissue (sinuses, nose, or lung)
• Most definitive test

KOH mount or fungal staining:

• Identifies fungal elements under a microscope

Culture test:

• Specifically identifies the fungus from tissue or fluid

Histopathology:

• Demos tissue invasion by fungi

Blood tests:

• Screen for immune function, kidney function, blood sugar

Black Fungus Risk Factors

Black fungus, or mucormycosis, is an aggressive fungal infection that mainly influences human beings with compromised immunity. The risk of infection will increase drastically while one or extra of the subsequent risk factors are present:

• Uncontrolled Diabetes
• COVID-19 Infection
• Excessive or Prolonged Steroid Use
• Immunosuppression
• Long ICU Stay or Hospitalization
• Iron Overload
• Skin Trauma or Wounds
• Malnutrition
• Environmental Exposure

Black Fungus in India

Black fungus (mucormycosis) became a serious public health difficulty in India, mainly throughout and after the second wave of COVID-19 in 2021. India saw one of the maximum international surges of mucormycosis cases at that point.

Why India Was Severely Affected?

• High Prevalence of Diabetes
• Steroid Misuse During COVID-19
• Prolonged Oxygen Therapy
• Poor Infection Control in Some Settings

Is black fungus contagious?

No, black fungus (mucormycosis) is not contagious.

It Does Not Spread:

• Person to person
• By touch, coughing, sneezing, or talking
• By eating, drinking, or using food and water, utensils

How It Spreads:

Black fungus is due to fungal spores (mucormycetes) found in the environment, particularly:

• Soil
• Rotting leaves or compost
• Animal feces
• Air (dusty, damp conditions)

People breathe in the spores, or the fungus gets in through wounds, cuts, or operating wounds, particularly when the immune system is compromised.

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