Black Fungus in COVID patients in Arkansas:
In a recent CDC MMWR it was reported that in September of 2021, 3 doctors notified the Arkansas Department of Health of many patients with mucormycosis following a bout of COVID-19.
What the heck is mucormycosis ?
Also called black fungus in the general public and mainstream, it’s a rare but severe fungus infection caused by mucormycetes, molds found throughout our envirnoment. These molds usually only become a health issue for people who have a compromised immune system, whether due to disease or medicines. The good news is that if you have a well-functioning immune system, you most likely will not have to worry about mucormycosis. Infection happens when an at-risk person inhales fungal spores into his/her lungs or the spores enter the body via a burn or cut on the skin. Symptoms vary and depend on where the fungus is in the body. If it infects the sinuses or brain, symptoms include facial swelling, headaches, congestion, black lesions on the nasal bridge or upper inside of the mouth that become more severe with time, and fever. If the fungal spores are in the lungs, symptoms include fever, cough, chest pain and shortness of breath. If the fungus infects the skin, lesions may appear and turn black. ( That’s why it’s called “Black Fungus.”) If the fungus gets inside the GI tract, a person may have abdominal pain, nausea and vomiting, and bleeding from the GI tract. Treatment includes prompt antifungal therapy and often requires surgery to remove the black fungus lesions. It has a relatively high mortality rate. I’ve seen ranges from 30-55%.
You might have heard about black fungus related to COVID patients in India. During the second wave of the pandemic, India got hit hard with cases of mucormycosis following a diagnosis of COVID-19. Scientific American has a thorough article on it here. In short, in a span of months India registered 12,000 cases. Many people presented with shortness of breath along with fever and pain/pressure behind their cheekbones and eyes.
Why would COVID-19 patients be at an increased risk of mucormycosis?
Well, if they have an underlying condition that weakens their immune system, that would increase their risk, but it also has to do with the types of medicines used to treat COVID patients, specifically high-dose steroids. Steroids can help reduce inflammation and calm the “cytokine storm” known to kill COVID patients, but by suppressing the immune system, they also put a person at risk for things like Black Fungus. Steroids help save you from death, but then you have fungal infections to fight off. The CDC MMWR also mentions that some scientists speculate that COVID itself may induce immune dysregulation.
Most of the buzz on Black Fungus and COVID patients has come out of India, so the Arkansas report was a bit of a surprise. The state normally reports 9 cases of Black Fungus in any given year, so 10 in a span of months is alarming. To summarize the MMWR, 10 COVID-19-associated mucormycosis infections were reported to Arkansas Department of Health from July through September. 9 of the patients lived in Arkansas with 1 being from out of state. All were unvaccinated. The median (most common) age was 57, age range was from 17-78, all patients were white and there were seven men and three women. One patient had a history of an organ transplant, a procedure that would put him at risk for mucormycosis. Another patient had an injury on the body, which served as the site of entry for the black fungus. Here’s the kicker in my opinion: 8 out of 10 had diabetes and uncontrolled Hemoglobin A1C values (8.6%). The Hemoglobin A1C value essentially tells you how well a person is controlling their blood sugar level. It should be below 5.7%. Having diabetes with an uncontrolled blood sugar level is a risk factor for Black Fungus. Combining that with a COVID-19 infection and subsequent treatment, well you got yourself a recipe for fungi.
On average, it took a little under 3 weeks for a person to test positive for mucormycosis from his/her initial COVID-19 diagnosis. 8 patients received oxygen for COVID-19; 5 were put on a ventilator; 9 took steroids; 2 took tocilizumab and 2 took baricitinib; 5 underwent surgery to remove the “black fungus” lesions; 6 of the patients died while in the hospital or within 1 week of discharge.
Will the US see more Black Fungus in COVID patients as the pandemic progresses? Maybe. America has a big problem with Type 2 Diabetes, and I’m sure a segment of those folks don’t control their blood sugar levels well. It also will depend on the frequency of steroid use and severity of infections as we tackle variant after variant. So far the “O variant” seems insanely infectious but less deadly than Delta, so perhaps it will just run through us, get us to herd immunity by early Spring, and then we won’t have to worry as much about COVID. One hopes.
Here’s a link to the article in CDC MMWR.
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