Deadly Black Fungus and Oral Care

“Deadly” – Black Fungus and Oral Care

The COVID pandemic was not enough, that there is another epidemic that has hit India. The ongoing phase has made us bow down towards the life threatening microorganisms. After this shattering viral disease, now we all have to protect ourselves from a serious fungal infection that has suddenly boomed and has increased the number of infections. Black fungus infection has been declared as an epidemic and a notifiable disease in some states of India.

What is Black Fungus?

Black fungus, also called Mucormycosis, is a disease caused by fungi belonging to the fungal family ‘Mucorales’. These fungi generally infect people with an impaired immune system.

Who is more likely to get this infection?

Black Fungus is commonly being observed in patients :

• suffering from COVID-19 and who were treated with steroids for a long time (Steroids increase blood sugar)
• who have been suffering from uncontrolled diabetes. Escalated blood sugar levels is one of the main reasons for the fungus to multiply. 
• who have been hospitalised for a long time (making them more prone to getting exposed to the fungal spores) 
• who were on oxygen support or ventilator (People undergoing oxygen therapy in ICU, where a humidifier is used, are more at risk due to exposure to moisture as fungi grows apt in such conditions)
• poor hospital hygiene (increases the chances of getting infected) 
• with a weakened immune system due to overuse of antibiotics and/or steroids.
• With cuts on skin from surgeries, transplants and burns.

Is Black Fungus contagious?

The disease is not contagious and doesn’t spread from one person to another.

How is Black Fungus spreading ?

The fungus lives throughout the environment and their spores are present in the air, particularly in soil and in association with decaying organic matter, such as leaves, compost piles, and animal dung. They are more common in soil than in air, and in summer and fall than in winter or spring. Most people come in contact with microscopic fungal spores every day, so it’s probably impossible to completely avoid coming in contact with mucormycetes. These fungi aren’t harmful to most people. However, for people who have weakened immune systems, breathing in mucormycete spores can cause an infection in the lungs or sinuses which can spread to other parts of the body.

The infection can also be caused by direct skin contact through wounds.

Why Black Fungus is occurring majorly in COVID 19 patients?

The Ministry of Health has confirmed that this infection is often occurring in COVID 19 patients either during the hospital stay or several days to a couple of weeks after discharge. The changes acquired in the patient’s body (host), makes it an optimal environment for the fungal growth. The COVID medications can make the body weak and lower down the immunity. Over use of medications like steroids, broad-spectrum antibiotics not only wipe out the potentially pathogenic microbes but also the protective microflora. Anti-fungals (voriconazole therapy) are ineffective in removing this particular strain of fungi.

Black Fungus Symptoms?

The prime symptom of the black fungus includes :

• discolouration of the oral tissues, tongue, gums.
• loosening of the teeth
• stuffy nose, 
• sinuses
• severe pain in teeth, check and eyes. 
• swelling of face, 
• heaviness below the eyes, 
• discomfort, 
• fever 
• headache.
• pulmonary mucormycosis:
  • Fever, cough, chest pain, pleural effusion, hemoptysis, worsening of respiratory symptoms.

Possible treatments of Black Fungus 

If not treated on time, the black fungus infection can turn fatal. The medical treatment for mucormycosis ranges from 6 to 12 weeks and is sometimes associated with adverse effects. Mucormycosis treatment is a debride treatment, which means that it has to be treated medically as well as surgically.

• Multi-Disciplinary Team approach is required : Primary Team MUST comprise of – Internal Medicine/ Pulmonologist, ENT, Endocrinologist & Ophthalmologist.
• Other specialists which may need to be involved: Microbiologist, Dentist, Intensivist, Neurologist, Neurosurgeon as needed.

Anti-fungal therapy majorly includes amphotericin B preparations which are administered by the specialist.

The fungus has to be removed surgically so that the penetration of anti-fungal drugs is much better into these areas. Surgery is very important in severe cases because the black fungus has to be completely scraped off and healthy tissue should be seen.

How can Black fungus be prevented?

Prevention is better than cure. According to dentists, one can reduce their chances of catching most of the viral and fungal infections including COVID and black fungus, by following some simple dental hygiene rules :

1. Maintain Oral Hygiene: After COVID recovery, the intake of steroids and other medication enables the bacteria or fungus in the mouth to grow and cause a problem in the sinus, lungs and even brain. Taking care of your mouth by brushing twice/thrice a day and taking oral cleanups can help exceedingly explained Dr. Gaurav Malik ( Director And Head, Department Of Dentistry, Max Super Speciality Hospital, Mohali ). Patients can also opt for medical cleaning of the mouth and restoring oral hygiene if they feel the need to.
2. Oral Rinsing: Maintaining good oral hygiene post-COVID-19 recovery is a must for patients to protect themselves from the effect of the disease. Change your toothbrush once test negative. Regular oral hygiene care by rinsing with mouthwash and povidone-iodine gargles must be done.
3. Disinfecting toothbrush and tongue cleaner: A COVID recovered patient should have a separate brush holder from rest of the family members. Clean your brush and tongue cleaner regularly using an antiseptic mouthwash.

Other preventive measures

Avoid fungal infection by taking certain other precautions like :

• Wearing a mask even after testing negative. 
• Strictly monitoring the sugar levels and keeping it in check.
• While administering oxygen to COVID patients, water for humidification/ oxygen therapy must be sterile and there should be no leakage from the humidifier.
• Maintenance of good hygiene and cleanliness is a must.
• Limit steroid usage. Strictly monitor sugar levels and keep it in check.
• Unnecessary use of broad-spectrum antibiotics, anti-fungals should not do as this removes the normal commensal flora resulting in the growth of unwanted organisms due to lack of competition.

The key take-home messages are that COVID-19 patients are more susceptible to this opportunistic fungal infection, hence awareness about this deadly disease among health care providers and the public is important, early diagnosis and timely treatment are paramount for improving outcomes in an otherwise dismal disease, preventive methods can protect us from these microbes.

Together we can definitely win this battle against COVID 19 and mucormycosis. For dental appointments, call +91-991-444-6677 or visit Max Dental Care.