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What is mucormycosis and is it related to COVID-19?

This article was published on
April 13, 2021

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May 27, 2021: Homeopathic treatments have not been proven as prevention, treatment, or curing methods for mucormycosis. Massaging with alum/salt/turmeric, steaming and applying mustard oil, or using cow ghee (on the skin, in the sinuses, in the eyes) are unlikely to prevent, treat, or cure this very serious infection.

Anyone who is suspected to have this major fungal infection should seek medical care right away. The India Council of Medical Research has issued guidance for screening, management, and diagnosis of mucormycosis. Their materials suggest "not to lose crucial time to initiate treatment for mucormycosis." Delaying prescription-issued antifungal medications may make the infection worse and may make treatment impossible. Doctors advise patients to seek medical help as soon as possible. They also advise patients not to self-medicate if they have symptoms of mucormycosis.

Mucormycosis and poultry: Mucormycosis is commonly found in dirt (or soil), animal manure (or dung), decaying plant materials (e.g., compost, fruits, vegetables, leaves), and in moist or wet areas. According to the U.S. Centers for Disease Control and Prevention (U.S. CDC), many people come into contact with fungal spores everyday. They also suggest that it is impossible to avoid coming into contact with mucormycetes (the types of fungi that cause mucormycosis).

The spores are not harmful for most people. Common risk factors for mucormycosis infection include immune system problems, diabetes or high blood sugar, past or current COVID-19 infection, and steroid treatments. To avoid infection, the India Council of Medical Research suggests that people "use masks if you are visiting dusty construction sites; wear shoes, long trousers, long sleeve shirts and gloves while handling soil (gardening), moss or manure; and maintain personal hygiene including thorough scrub bath." The U.S. CDC suggests similar actions and include avoiding water damaged buildings after floods or heavy rains. They note that these preventive measures "haven’t been proven to prevent mucormycosis."

Chickens (or poultry) can develop mucormycosis. The infection usually happens in chickens with immune problems because of stress, malnutrition, and environmental factors. However, mucormycosis does not spread between humans and animals. There is no evidence to suggest that people become infected with mucormycosis by eating cooked chicken. Raw chicken should never be eaten since there is a high risk of foodborne illness from bacteria like camphylobacer and salmonella.

May 24, 2021: Cases of mucormycosis, also known as "black fungus" have been rapidly increasing in India in recent weeks. Some social media posts show videos of a doctor suggesting the use of alum, turmeric, and salt to rinse one's mouth, as well as applying mustard oil to nostrils after inhaling steam and applying clarified butter as eye drops to prevent black fungus.

Alum is a mineral salt (potassium aluminum sulfate) that has been used in India traditionally as a home remedy for many purposes, including for oral health. There exist several scientific publications which confirm the benefits of alum as an antimicrobial. It is found as an active ingredient in some medicated mouthwashes. Similarly, the use of turmeric for its medicinal properties is well documented. However, there is no scientific evidence that shows that the use of these substances can prevent severe black fungal infection.

A combination of factors, including weakened immunity and other co-morbidities could be causing black fungus infection. A scientifically unproven topical oral rinse might not be adequate to prevent such a life-threatening infection. It is recommended that medical advice be sought when dealing with any symptoms of this infection.

Mucormycosis is a rare but very severe fungal infection that mostly impacts people with weakened immune systems. The infection is likely connected to COVID-19 for a number of reasons, including because of COVID-19’s weakening of the immune system, COVID-19’s connection to other conditions such as diabetes that weaken the immune system, and the use of steroids to treat COVID-19 that weaken the immune system.

Mucormycosis is a rare but very severe fungal infection that mostly impacts people with weakened immune systems. The infection is likely connected to COVID-19 for a number of reasons, including because of COVID-19’s weakening of the immune system, COVID-19’s connection to other conditions such as diabetes that weaken the immune system, and the use of steroids to treat COVID-19 that weaken the immune system.

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What our experts say

Mucormycosis is a rare but severe fungal infection that primarily affects the nose, eyes, and sometimes the brain. The infection is caused by a group of fungi called mucormycetes. They are found naturally in soil, leaves, and decaying fruits and vegetables, and they thrive in damp conditions. 

Most people come into contact with tiny fungal spores every day, which means most people do not completely avoid mucormycetes. For many, coming into contact with mucormycetes is not harmful. However, for people with weakened immune systems, these fungi can cause an infection that tends to start in the lungs or sinuses and spreads to the rest of the body. Because mucormycosis has a mortality rate of 50%, it’s important to prevent infection before an individual becomes sick.

Mucormycosis can impact the respiratory tract and blood vessels before spreading to different organs including the eyes and brain. This disease can lead to multiple organ failure if left untreated or treated at an incorrect time. The fungal infection also damages the body's immune system. For patients who are already suffering from compromised immune systems, mucormycosis can worsen those health impacts while causing damage of its own.

Mucormycosis is believed to be connected to COVID-19 through a number of pathways. First, COVID-19 weakens the immune system, making someone more vulnerable to mucormycosis infection. Second, most people with severe cases of COVID-19 also have other health conditions, such as heart problems or diabetes, which also lower the body’s immune system. Diabetes, in particular, has been shown to be strongly associated with mucormycosis. 

An increased use of steroids to treat hospitalized COVID-19 patients could also be leading to higher cases of mucormycosis infection. Steroids help reduce inflammation in the lungs and stop some of the damage that can occur. However, steroids also lower immunity and increase blood sugar levels for COVID-19 patients, whether or not they have diabetes. Some health experts are also concerned that people are using oxygen therapy at home without proper hygiene, which could be increasing exposure to mucormycetes. 

Finally, and most likely, it is a combination of these factors that is leading to an increase in fatal fungal infections among COVID-19 patients. For example, a patient may already have a weakened immune system due to diabetes, which then gets weakened even further because of COVID-19, and then further still because of the use of steroids. Mucormycosis is of growing concern to doctors and public health experts and will continue to be monitored among COVID-19 patients.

Context and background

Mucormycosis among COVID-19 patients has been of growing concern as cases of patients with both COVID-19 and mucormycosis have increased, particularly in India across the country as of early April, 2021. 

Two reasons why this co-occurrence may be taking place are 1) because of such a high increase in COVID-19 case numbers, which puts a higher number people at lowered immunity, and 2) because a large portion of the Indian population has diabetes which is strongly correlated with mucormycosis (77 million people have diabetes, which is more than 10% of the adult population).

Importantly, not only people with diabetes have gotten mucormycosis. For instance, some young people without diabetes (but infected with COVID-19) have been infected with mucormycosis. This could be due to a weakened immune system from the virus or from steroids. More monitoring and research is needed to further understand the link between mucormycosis and COVID-19.

Resources

  1. Mucormycosis (Centers for Disease Control and Prevention)
  2. A Case of Fatal Rhino-Orbital Mucormycosis Associated With New Onset Diabetic Ketoacidosis and COVID-19 (Cureus)
  3. COVID-19 and orbital mucormycosis (Indian Journal of Ophthalmology)
  4. COVID-19 triggering mucormycosis in a susceptible patient: a new phenomenon in the developing world? (British Medical Journal Case Reports)
  5. Mucormycosis after Coronavirus disease 2019 infection in a heart transplant recipient – Case report and review of literature (Journal of Medical Mycology)
  6. A potentially fatal fungal infection is cropping up among India’s Covid patients. (The New York Times)
  7. Mucormycosis: The 'black fungus' maiming Covid patients in India (British Broadcasting Corporation)
  8. Claims in viral video about 'alum, turmeric' treatment of black fungus fake: Govt (Public Information Bureau)
  9. Fact Check: Can black fungus be cured by turmeric, rock salt, alum and mustard oil? (Times of India)
  10. Comparative evaluation of the effects of an alum-containing mouthrinse and a saturated saline rinse on the salivary levels of Streptococcus mutans (JISPPD)
  11. Effect of supervised use of an alum mouthrinse on dental caries incidence in caries-susceptible children: a pilot study (ASDC J Dent. Child)
  12. Evaluation of an alum-containing mouthrinse in children for plaque and gingivitis inhibition during 4 weeks of supervised use (AAPD)
  13. Curcumin: A Review of Its’ Effects on Human Health (Foods Journal)
  14. Screening, Diagnosis, and Management of Mucormycosis (ICMR)
  15. AIIMS releases guidelines for early detection, prevention of mucormycosis, Covid ward on alert (Times Now News)
  16. Where Mucormycosis Comes From (U.S. CDC)
  17. People at Risk & Prevention (U.S. CDC)
  18. Chicken and Food Poisoning (U.S. CDC)
  19. Mycoses in Poultry (Veterinaria Digital)

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