Black fungus and Covid-19: What you need to know

Multiple reports from India have raised the alarm that a spate of mucormycosis, a rare black fungal infection, has been linked to the ongoing Covid-19 pandemic.

Recently reported infections have left several patients worse for wear, even leading to major disfigurement and death in some cases.

This has led to South African experts warning about the increased risk of infection some people face which is compounded by Covid-19, especially considering the variant ravaging India and which has been classified as a variant of concern in South Africa.

According to the Global Action Fund for Global Infections, high numbers of cases have been seen in the Indian provinces of Gujrat, Maharastra, Karnataka, Tamil Nadu, Andhra Pradesh, Delhi, Chandigarh and Punjab. The country is also in the midst of a ravaging third wave of Covid-19 infections spurred on by the new variant B.1.617.

Though no reported cases exist in South Africa, the National Institute for Communicable Diseases (NICD) says at least 80 cases of Covid-related mucormycosis have been detected overseas. The illness, which is caused by inhaling black mold, has been reported in medical literature to date.

According to Professor Nelesh Govender, the head of the NICD’s Center For Health-Care Associated Infections, Anti-microbial Resistance and Mycoses, the two outbreaks are correlated.

What causes it?

Mucormycosis is caused by several different fungi found in the environment. The fungal spores are inhaled and lodge in the nasal passages, sinuses and lungs.

Who is at risk?

In healthy people, black mold causes no ill effects, but in people with weakened immune systems, this can develop a serious fungal illness. Immuno-compromised people at risk of contracting mucormycosis include:

• Those with poorly-controlled diabetes (with high blood sugar and acid levels)
• People receiving medicines that weaken their immune systems, for example corticosteroids.
• People hospitalised with Covid-19 who are treated with corticosteroids
• People with Covid-19 and other risk factors. These people may develop mucormycosis in hospital or in the days or weeks after discharge.

According to Professor Carlien Pohl-Albertyn, associate professor in microbiology at the University of the Free State, severe Covid-19 causes changes in the immune system, such as increased release of cytokines (molecules involved in inflammation) and a decrease in certain white blood cells (which help to fight other infections).

These changes could make patients more susceptible to invasive fungal infections.

“Severe SARS CoV-2 infection also damages the lung tissue, making it easier for inhaled fungi (such as Aspergillus species, Cryptococus neoformans, and mucoralean fungi) to cause invasive infections,” she says.

Symptoms

People with mucormycosis may complain of a headache on one side, a blocked or stuffy nose and sinuses on the same side, and/or a swollen eye on the same side and areas of skin blackening on the face.

Black areas may also form on the palate in the mouth. Govender warns this is a medical emergency that needs very urgent surgical and antifungal treatment. It is also essential to control the underlying problem, such as controlling high blood sugar and acid levels, if the person has uncontrolled diabetes.

How can it be prevented?

Pohl-Albertyn says the fungal infection has mostly been  associated with hospitals, particularly intensive care units (ICUs) in cases where inadequate hygiene has been practised.

Prevention protocols include sanitising, washing hands and cleaning surfaces properly with the correct disinfectant, including bleach.

“It depends on how well these measures are put in place.  It is similar to how certain bacterial infections are prevented in hospitals as well. If your sanitation protocols are in place and done properly, it shouldn’t be a problem, but that is not always the case unfortunately,” she says.

Is South Africa at risk?

Pohl-Albertyn and Dr Obinna Ezeokoli who are researchers at the University of Free State’s school of microbiology say studies conducted before the current Covid-19 pandemic have shown that fungal infections are highly prevalent in the South African population, partly owing to the high incidence of HIV.

Co-infections with opportunistic fungal species may be affecting the current Covid-19 disease statistics in South Africa, say the researchers.

This is because of the high prevalence of HIV/Aids in South Africa as well as the high number of persons undergoing immunosuppressive therapies for other illnesses.

It was observed that the Candida carrier rate is higher in the South African population than elsewhere and that HIV-positive patients carry more, and a greater variety of pathogenic yeasts compared to HIV-negative subjects.

Another fungal infection called cryptococcal meningitis is one of the leading causes of HIV-related deaths in South Africa, with more than 135,900 deaths estimated for sub-Saharan Africa in 2014.

Simnikiweh@citizen.co.za