Mucormycosis, an infection of a rare “black fungus” that is difficult to treat and has an incredibly poor prognosis, with an overall all-cause mortality rate of 54%, has emerged in India amidst the COVID-19 pandemic that remains out of control in the country. As of May, more than 300 cases have been reported in just four of India’s cities. There is concern that these figures are just the beginning, and as the pandemic wears on, cases of mucormycosis will continue to surge.
Scientists have linked increases in mucormycosis cases to the COVID-19 pandemic as they believe the disease presents the perfect opportunity for the rare fungus to take hold. Steroids used to treat inflammation in COVID-19 also lower the immune system, making it easier for other infectious pathogens to infiltrate and wreak havoc. Additionally, recent mucormycosis cases in India have commonly been reported in those with diabetes, a condition that also has the impact of lowering the body’s immune responses.
As mucormycosis is difficult to treat, and much anecdotal evidence from the cases in India have highlighted that patients are leaving it too long before they seek medical attention, resulting in worse outcomes, there is a great emphasis on the urgency of communicating the nature of mucormycosis, the severity of the disease, and when to see a medical professional. Here, we discuss the symptoms of mucormycosis in detail.
Mucormycosis. Image Credit: David A Litman/Shutterstock.com
Symptoms of mucormycosis
The most characteristic symptom of mucormycosis is a facial deformity that develops as the black fungus spreads through the body. Other common and highly noticeable symptoms are impairments to the senses and vital organs.
Overall, mucormycosis presents a wide range of symptoms. Depending on the patient, and on the location of the infection, these symptoms can vary. Symptoms can be grouped in terms of area of infection. When mucormycosis infects the brain and the sinuses, referred to as rhinocerebral mucormycosis, patients often present the following symptoms: black lesions on nasal bridge or upper inside of the mouth, headache, fever, nasal or sinus congestion, and one-sided facial swelling. Infections of the lung, known as pulmonary mucormycosis commonly include chest pain, cough, fever, and shortness of breath.
When mucormycosis infects the skin (cutaneous mucormycosis), which usually happens if the patient has a cut or wound, symptoms usually include: blisters and ulcers on the skin, pain, warmth, and excessive redness and swelling around the wound. Gastrointestinal mucormycosis, when the fungus infects the gastrointestinal tract, usually presents the following symptoms: bleeding, nausea, and vomiting.
With a wide range of symptoms, it can be difficult for those at risk of mucormycosis to know what to look out for or to know when is appropriate to seek medical attention. Given the ruthless nature of mucormycosis, anyone who suspects that they may be infected should seek medical attention sooner rather than later to increase their chances of recovery and of avoiding the more severe effects of mucormycosis.
However, some of the most intense symptoms include severe headaches, impaired vision, facial swelling, confusion, and cognitive impairment, and discoloration around the nose. These symptoms can help identify mucormycosis. We have discussed them in detail below.
Painful headaches are common with mucormycosis. The infection often enters the body through the nasal tract as the person unwillingly inhales spores. Via this route, the fungus has the opportunity to attack the nerves and sinus cavities, which produces symptoms such a pain severe headaches.
Another common and concerning symptom of mucormycosis is impaired vision. Often, patients with mucormycosis experience change in vision. Visual symptoms can be signs that the infection is spreading, meaning that it is important for patients to seek medical attention before visual symptoms setting in. As the fungus grows, it can cause swelling in an individual eye and can produce hazy or poor vision as well as bloodshot eyes.
Facial swelling is another characteristic symptom of mucormycosis, with swelling often presenting on the cheekbone along with localized pain in the area. This pain and swelling often occurs on one side of the face and can also occur with numbness. As well as facial swelling, the infection can impact the skin, creating lesions and necrosis-like symptoms.
Another common facial symptom of mucormycosis is discoloration around the bridge of the nose. This symptom is considered to be the primary feature of the infection. This can occur alongside swelling around the nose as well as the disintegration of the septum. In severe cases, the discoloration can develop into black patches around the nose and eyes. Patients also sometimes lose their teeth or jaws due to sporadic fungal growth.
Finally, mucormycosis also presents psychological symptoms. Patients with mucormycosis can often experience confusion and cognitive impairment as the infection spreads to the brain. Doctors emphasize the importance of seeking medical attention when experiencing altered mental states, delirium, memory, or neurological impairment.
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