Black, White, and Yellow Fungus during the Covid-19 Pandemic: Signs to watch out for

Introduction

The COVID-19 pandemic has brought along with it many difficult challenges or complications. India is now facing the attack of life-threatening fungus infections to covid suffering or covid recovered patients (2-4 weeks) during the pandemic. Initially, it was the black fungus, and gradually scientists found the existence of white and yellow fungus. India has registered 11,700 cases of Black Fungus till May 25, 2021. Here in this blog, we would brief on what these fungus diseases are, their symptoms, and risk factors? Finally, we will know how to manage if you get this disease and what guidelines people should follow to prevent themselves from getting this disease.

What is Black Fungus/ Mucormycosis?

Black Fungus disease is a life-threatening but rare fungal infection caused by mucormycetes. The mucormycetes are a group of molds belonging to the order Mucorales. The fungi that have been isolated from more than 70% of cases of mucormycosis is Rhizopusoryzae. A weakened immune system and an infected lung, as in COVID-19, leads to the easy entry of fungal spores into the body to germinate and attack the tissues. Mucormycosis most often spreads across the nose and sinuses. From there, it spreads to the eyes, causing blindness or cause headaches, and seizures. The fungal infection is called black fungus because after the attack of the fungus on the nose, face, eye orbits, lungs, and brain, the tissues turn black as they are dead.

Warning Signs and Symptoms for Black Fungus

Once the fungal spores are inhaled, they invade the sinuses or lungs of the patient. This leads to severe disease with the following warning signs and symptoms:

• Pain and redness around eyes or nose
• The bridge of the nose/palate turns blackish
• Blurred vision with pain, fever, skin lesion, thrombosis, and necrosis
• Headache and Toothache
• Coughing
• Shortness of breath and chest pain
• Blood in vomits
• Altered Mental Status
• One-sided facial pain, numbness, or swelling.

What is White Fungus/ Candida or Aspergillus?

White fungus infection is dangerous than black fungus infection. It affects not only the lungs but also the nails, skin, kidneys, and brain. Recently, there has been a case where the white fungus has been found to cause a hole in the intestine of women in New Delhi, India. The infection can be caused due to low immunity in COVID-19 people when they contact a surface containing the Rhizopusoryzae fungus. This can be unhygienic water and other unsanitary environments. White fungus is dangerous than black fungus because it causes damage to vital organs that may lead to the breakdown of CNS, respiratory organs, digestive tract, kidneys, nail beds, or even private parts. The fungal infection is called white fungus because of white color discharge from the patient's private parts.

Warning Signs and Symptoms of White Fungus

The majority of persons infected with the white fungus had respiratory symptoms similar to COVID-19, but they tested negative for the virus. According to experts, X-rays or chest scans can precisely anticipate the severity of the disease. Some of the symptoms of white fungus include:

• Fever and Cough
• Diarrohea
• Dark spots on lungs
• Difficulty in breathing
• Infections
• Persistent headaches
• Chest pain

What is Yellow Fungus /Mucor Septic?

Yellow Fungus is a more deadly fungal infection than the black and white fungus as it begins internally. It is dangerous as the symptoms of the disease are not visible outside, which delays diagnosis. The fungal infection is called yellow fungus, as the pus formed in the wounded area is yellow.

Warning Signs and Symptoms of Yellow Fungus

Initial warning signs

• Loss of appetite
• Lethargy
• Weight Loss

Later stage symptoms

• Sunken eyes due to malnutrition and organ failure
• Delay in the healing of wounds
• Oozing of pus from wounds
• Necrosis

Risk Factors for Black Fungus, White Fungus, and Yellow Fungus Disease

Patients with the following risk factors are more prone to get this fungal disease that includes:

• COVID-19 patients who suffer from Diabetes mellitus and have uncontrolled sugar intake in the diet.
• People with comorbid disorders who have been taking immunosuppressive steroid drugs for a more extended period to treat pre-existing diseases, as well as COVID-19.
• Being admitted to a hospital's Intensive Care Unit for an extended period.
• The presence of comorbidities like the history of organ transplant operations or cancer treatment procedures decreases the strength of the immune system.
• Those patients who are already taking prescription antifungal drugs like Voriconazole to combat infections.
• Unsanitary/ Unhygienic environment
• Cancer & HIV
• Transplant surgery
• Use of unfiltered tap water in humidifiers/oxygen cylinders

Management of Fungal Infections

The Indian Council of Medical Research (ICMR) has laid out advisory guidelines for the management of Mucormycosis during the time of COVID-19.

• Patients need to control diabetes and diabetic ketoacidosis
• Immunomodulating drugs should be discontinued
• Antifungal prophylaxis is not needed
• Necrotic materials should be removed through extensive surgery
• Amphotericin B should be infused after infusing Normal saline as IV
• Antifungal therapy needs to be carried out for 4-6 weeks
• Patients should be constantly monitored and the disease progression should be checked through radio-imaging technique.

The ICMR has also put guidelines on how to prevent getting a fungal infection during COVID-19.

• People should avoid crowded places and maintain social distancing.
• People should wear masks and wash their hands properly
• Keep your surroundings clean and take a regular bath.
• People working at a construction site should have a proper face mask.
• Avoid eating too much sugar in diet and control diabetes.