An In-Depth Clinical Guide for Readers of Nellikka.life

During the COVID-19 pandemic, a frightening word entered public discussion — “Black Fungus.”
The medical term is Mucormycosis, a rare but aggressive fungal infection that can become life-threatening if not diagnosed and treated early.

Although it gained attention during the pandemic, mucormycosis is not new. It has existed for decades — primarily affecting individuals with weakened immunity.

Let us understand this condition scientifically, calmly, and clearly.

What Is Mucormycosis?

Mucormycosis is a serious fungal infection caused by molds belonging to a group called Mucorales.

These fungi are commonly found in:

• Soil
• Decaying leaves
• Compost
• Animal dung
• Air (spores)

In healthy individuals, inhaling these spores usually causes no harm.
But in people with compromised immunity, the fungus can invade tissues and spread rapidly.

Why Did Mucormycosis Rise During COVID-19?

The surge seen during the pandemic, particularly in India, was linked to several risk factors:

Uncontrolled Diabetes

India has one of the highest populations of people with diabetes. High blood sugar weakens immune defenses and creates an ideal environment for fungal growth.

Steroid Use

Steroids were lifesaving in severe COVID cases. However:

• Excessive or prolonged steroid use
• Self-medication
• Poor glucose monitoring

increased susceptibility to fungal infections.

Prolonged ICU Stay

• Oxygen therapy
• Mechanical ventilation
• Broad-spectrum antibiotics

These can alter natural microbial balance and immune function.

Types of Mucormycosis

Mucormycosis can affect different parts of the body.

Rhino-Orbital-Cerebral Mucormycosis

Most common during COVID.

Affects:

• Nose
• Sinuses
• Eye
• Brain

Symptoms:

• Facial pain or swelling
• Nasal blockage
• Blackish discharge from nose
• Vision changes
• Swelling around eyes
• Headache

This form can spread to the brain if untreated.

Pulmonary Mucormycosis

Affects lungs.

Symptoms:

• Fever
• Cough
• Chest pain
• Breathlessness

Often seen in cancer patients or transplant recipients.

Cutaneous Mucormycosis

Affects skin through wounds or burns.

Symptoms:

• Redness
• Swelling
• Blackish discoloration
• Rapid tissue damage

Gastrointestinal Mucormycosis

Rare but serious, mostly in malnourished or immunocompromised individuals.

Why Is It Dangerous?

Mucormycosis is aggressive because:

• The fungus invades blood vessels.
• It causes tissue necrosis (death).
• It spreads rapidly.

This vascular invasion is why affected tissue may turn black — hence the nickname “black fungus.”

How Is It Diagnosed?

Early diagnosis saves lives.

Doctors may use:

• Nasal endoscopy
• CT scan or MRI
• Tissue biopsy
• Fungal culture
• Histopathological examination

Imaging helps assess spread, especially to orbit or brain.

Treatment: A Medical Emergency

Mucormycosis requires urgent and aggressive treatment.

Antifungal Therapy

The primary drug is:

• Intravenous Amphotericin B

Newer antifungals like Posaconazole or Isavuconazole may be used in certain cases.

Treatment may last weeks to months.

Surgical Debridement

Dead and infected tissue must often be removed surgically.

In severe cases:

• Sinus surgery
• Eye removal (orbital exenteration)
• Brain surgery

These are life-saving measures when infection spreads.

Control Underlying Conditions

• Strict blood sugar control
• Reduce or stop steroids (if possible)
• Manage immunosuppression

Without correcting these, treatment may fail.

Mortality and Outcomes

Mucormycosis has a high mortality rate if untreated.

However:

• Early detection
• Prompt antifungal therapy
• Timely surgery

significantly improve survival rates.

Awareness is critical.

Who Is at High Risk?

• People with uncontrolled diabetes
• Cancer patients
• Organ transplant recipients
• Long-term steroid users
• COVID patients with high oxygen support
• Individuals with weakened immunity

Healthy individuals rarely develop this infection.

Can It Be Prevented?

While spores are everywhere and cannot be eliminated completely, risk can be reduced by:

Good Diabetes Control

Maintain HbA1c within recommended limits.

Judicious Steroid Use

Use steroids only under medical supervision.

Proper Wound Care

Clean injuries thoroughly.

Avoid Self-Medication

Especially in post-COVID recovery.

Maintain Hygiene in Humid Environments

Why India Saw Higher Numbers

Several factors contributed:

• High diabetes prevalence
• Warm, humid climate
• Widespread steroid use
• Overburdened healthcare systems during pandemic

The combination created a “perfect storm.”

Psychological Impact

The surge created fear and stigma.

Many patients suffered:

• Facial disfigurement
• Vision loss
• Emotional trauma

Rehabilitation and psychological support are equally important in recovery.

What Science Says Today

Post-pandemic data shows:

• Incidence has reduced significantly.
• Awareness has improved early detection.
• Guidelines for steroid use are now stricter.
• Diabetes control programs are being strengthened.

Mucormycosis remains rare in the general population.

Mucormycosis is not a mysterious disease.

It is a serious fungal infection that primarily affects vulnerable individuals.

The lesson from the pandemic is clear:

• Immunity matters.
• Chronic diseases must be controlled.
• Self-medication can be dangerous.
• Early symptoms should never be ignored.

Medical science has effective treatments — but timing is everything.

If you or a loved one has diabetes or immune compromise, stay alert but not anxious.

Awareness saves lives. Panic does not.