TEMPO.CO, Jakarta – The spike in cases mucormicosis in India occurred along with the high spike in Covid-19 cases, especially in the period of May 2021. In patients with severe degrees of Covid-19 there is a serious immune system disorder and is at risk for systemic fungal infections.
Doctor Specialist Pulmonology and Respiratory Medicine (Lung) from the Faculty of Medicine, University of Indonesia (FKUI) Anna Rozaliyani said vigilance against fungal infections must continue after the patient is declared cured (post-Covid-19).
“This is because the immune system” patient usually not fully recovered, so the risk of systemic fungal infection still exists,” he said in the virtual event of the FKUI Cares for Covid-19 Media Gathering, Friday, June 4, 2021.
For information, Anna explained, the term black fungus or black fungal infection in India is not appropriate because the case is mucormycosis, a fungal infection caused by Mucormycetes.
Mucormycosis is a systemic fungal infection caused by the Mucormycetes group (Rhizopus spp, Mucor spp, Rhizomucor spp, Cunninghamella bertholletiae, Apophysomyces spp, and Lichtheimia). Mucormycetes are not a group of black fungi (Dematiaceae). “Although this fungus causes black tissue abnormalities,” said Anna.
Systemic fungal infections, especially mucormycosis in Covid-19 patients, occur due to several conditions, namely interference and even paralysis of the immune system so that the body is unable to eliminate or prevent fungal invasion into the body.
Then the condition of diabetes mellitus with uncontrolled blood sugar, massive corticosteroid administration for a long time, the use of anti-inflammatory drugs, such as tocilizumab, and increased levels of ferritin (iron). In addition, the possibility of the emergence of sources of infection from the surrounding environment patients or fungal contamination of hospital facilities or equipment.
“Mucormycosis and other systemic fungal infections have the potential to cause complications that aggravate the condition of Covid-19 patients, and increase the risk of death,” he said.
Another danger, the higher the cost of hospitalization due to fungal infections. This is related to the amount of examination and treatment costs that must be given, longer hospital stays, and the number of health workers who must be available to treat patients with severe or critical conditions.
Besides Covid-19 patients, who is at risk for mucormycosis? The groups most at risk of developing mucormycosis include diabetic patients, especially those with diabetic ketoacidosis; cancer patients and organ transplant recipients; prolonged neutropenic conditions; and patients with hemochromatosis (excess iron).
In addition, there is also a group with skin injuries due to surgery, burns, natural disasters; low birth weight or premature babies; seriously ill or critically ill patients receiving corticosteroids or other immunocompromising medications; and patients with chronic renal failure and/or undergoing hemodialysis. “As well as HIV patients, injection drug use, and other immunocompromised conditions.”
Symptoms that occur also depend on the type of mucormycosis or the infected body part. In rhinocerebral mucormycosis, infection occurs in the sinus cavities, can spread to the brain, and is most common in patients with uncontrolled diabetes or kidney transplant patients.
Symptoms of rhinocerebral mucormycosis are facial swelling on one side, headache, nasal congestion, fever, black abnormality (Fig.black eschar) in the nose or upper mouth. Pulmonary mucormycosis is the most common in cancer or transplant patients.
“The symptoms are fever accompanied by cough, chest pain, shortness of breath, and others, which do not improve with standard treatment,” said Anna, who is also a member of the Indonesian pulmonary doctors association.
Then there is gastrointestinal mucormycosis, a gastrointestinal infection that is more common in pediatric patients, especially premature infants receiving systemic antibiotics, steroids, surgery, and others. Symptoms can include abdominal pain, nausea, vomiting, and gastrointestinal bleeding.
In addition, skin mucormycosis that occurs through wounds on the skin (eg after surgery, burns, etc.). Symptoms can look like blisters or ulcers, and the infected area turns black. Other symptoms include pain, warmth, excessive redness, or swelling around the wound.
There is also disseminated mucormycosis, an infection that spreads through the bloodstream, can spread to other organs, including the brain, spleen, heart, and others. Usually occurs in conditions of severe illness, and it is difficult to know the specific symptoms. “Patients with brain infections can experience changes in mental status or coma,” said Anna.
Read:
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