May 18: In the face of this pandemic when the whole world is grappling with different challenges we have our own unique problem, Rhinocerebral Mucormycosis aka ‘Black Fungus’. It is not something new, but it was never this common.
In simple words it is an opportunistic fungal infection of nose and sinuses affecting predominantly immunocompromised and highly diabetic patients. In the past the occurrence was as less as 1 to 2 cases in a year in any tertiary care centre. In my early years as a consultant I had operated on 3 cases over a period of 2 years and published it in a peer reviewed journal and to my surprise a physician from Srinagar had called me to ask about my experience as they had not seen any cases, it was that uncommon.
So what happened in these past few months that suddenly it is all over the news? COVID caught all of us unprepared without any guidelines about management, almost everyday newer guidelines were sent and we are constantly adapting. Out of all the information in hand few highlights emerged, we need to give oxygen and improve lung functions. In light of which steroids and immune modulators were used to suppress the hyper immune response in order to save life. It worked and survival improved. However, with every good comes the evil. What also happened was that sugars shot up, pre existing diabetics became worse and new diabetics emerged. This combination of indiscriminate steroid use, self medication and poor glycemic control gave a perfect environment for the BLACK FUNGUS to grow. Like a silent player it got comfortable in our nose and saw an opportunity to shine and grabbed it with both its hands and started making noise. Do not worry we have your back.
How do I know if I’ve black fungus infection?
Common symptoms: Facial pain, focal headaches especially over forehead, temple and vertex. Toothache (upper jaw), eye pain, nose block, blood stained discharge. More alarming features like: visual disturbance, double vision, fever, splitting headache, seizures, stroke or paralysis.
If you have any of these seek immediate medical help.
What will a clinician do?
If BLACK FUNFUS infection is suspected then you would be referred to an ENT surgeon who will do a detailed clinical examination and ask for either a CT or an MRI scan. He can also do an endoscopy to confirm the diagnosis and send a swab for fungal studies. In any situation you will have to follow up with the reports.
What am I to do if I am diagnosed with BLACK FUNGUS?
First do not worry, stay positive and motivated. In most of the cases you would be explained about the need for surgery (with few exceptions), usually endoscopic. Surgery is a bit aggressive to contain a relatively lethal disease which may involve removal of facial bone and adjacent non bony structures. This will be followed by anti fungal injections for at least a week. You will be monitored closely with serial examinations and blood tests. Sometimes the treatment is protracted and might warrant repeated debridements and longer hospital stay, a lot depends on patient response to treatment.
TIME is of the essence here. Seek medical help at the earliest, delay can cost you your life.
There is a sudden surge of BLACK FUNGUS infection across the country further strangulating the already strained medical healthcare system but, we are here to help. We can fight if we act now.
Dr Vinay V Rao is an Associate Professor in ENT & Head Neck Surgery at Fr Muller Medical College, Mangaluru. He is a Consultant ENT specialist at Valencia health center, Valencia. Contact at 8050076660, [email protected]