Fungus is commonly found in our environment and mostly seen in the soil in many parts of the world in various forms.
Infection to humans is common, particularly externally on skin and nails, but sometimes also affecting the internal organs.
Recently, a particular fungus called the black fungus has hit the news due to the Covid-19 pandemic.
Rare before the pandemic, this type of fungal infection, known as mucormycosis, involves the sinuses and nasal cavities.
To the naked eye, its manifestation looks black, hence why it is commonly known as black fungus.
There has been a surge of reported cases in India, particularly during the country’s current wave of Covid-19 cases.
This is very worrying as this infection is extremely life-threatening.
While this fungus primarily infects the nasal cavities, it has the capacity to invade and spread into all the neighbouring structures like the eyes and the brain (termed as rhino-orbital-cerebral invasive fungus).
The progress is rapid, and once the brain is involved, death is certain.
Infection usually occurs when fungal spores that predominantly originate from the soil settle into a person’s nasal cavities.
In a healthy individual, there is usually a strong immune response that protects against further growth of the fungus.
However, when the person’s immune system is compromised – in a Covid-19 patient, particularly those on steroid therapy, and certain medical conditions like diabetes, for example – this will allow the fungus to invade normal tissues within the sinuses.
The blood vessels will be affected, causing thrombosis (localised blood clotting) that will result in blockage of the blood vessels, which will cause the tissues and lining of the nose to die off, allowing the fungus to spread deeper.
While some patients may have no symptoms, some early signs that need to be paid attention to are nasal blockage and facial pain associated with pain behind the eye and loss of vision.
When the fungus has invaded deeper into the head, the intensity of pain will increase and may be accompanied by loosening teeth, ulcers in the hard plate and blindness.
The infection can be diagnosed via endoscopy to examine the nasal cavity.
Erosion and defects should be easily seen, along with black and/or grey debris.
A CT (computed tomography) scan of the sinuses and MRI (magnetic resonance imaging) of the head will be able to establish the extent of the fungal infection and invasion to other deeper organs around the sinuses.
A sample can be sent for lab testing, but the results are often very indefinite.
Once diagnosed, comprehensive nasal surgery with an endoscope will be done to debride or remove every part of the infected areas in the nose, sinus, eye(s) and brain.
Anti-fungal medication, such as amphotericin B lipid complex or liposomal amphotericin B plus, will then be prescribed.
These medications can be lethal as they have significant side effects, particularly to the kidneys, hence proper monitoring by doctors is essential.
In most instances, when the fungus has invaded most of the vital organs in the head, the chances of death are extremely high.
Early detection and intervention is crucial to save lives, and also to preserve important organs like the eyes and prevent spread into the brain.
Currently, Malaysia has very few such cases reported, although there is a slight increase in number compared to previously.
The numbers currently being seen in India are worrying and the potential to have an increase in black fungus cases in Malaysia is possible.
Datuk Dr Kuljit Singh is a consultant ear, nose and throat (ENT) surgeon. For more information, email starhealth@thestar.com.my. The information provided is for educational purposes only and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this article. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
