Apart from spreading like wildfire, the second wave of COVID-19 is leaving after-effects of misery in the form of fungal infections. Thereby, increasing the burden on our country that is already gasping under the fear of novel coronavirus.
COVID-19 And Fungal Infections: Who Is At Risk?
Fungal infections (‘mycosis’) are caused by pathogens called ‘fungi’. These infections are opportunistic, meaning they infect people whose immune system is severely weakened. Such infections can cause symptoms such as fever, cough, and shortness of breath [1,2]. Fungal infections in COVID-19 patients are more prone in people with severe COVID-19 or those admitted to ICU [3].
Fungal Diseases Being Noticed Among Covid-19 Patients
Common fungal infections in COVID-19 patients include [4]:
1. Mucormycosis or Zygomycosis (Black Fungus)
2. Candidiasis (White Fungus)
3. COVID-19 associated pulmonary Aspergillosis (CAPA)
4. Candida auris infection
5. Cryptococcus neoformans infection
6. Pneumocystis pneumonia (PCP)
7. Talaromycosis
8. Fungal Pneumonia (valley fever, histoplasmosis, and blastomycosis)
Let’s understand a few of these fungal infections that are commonly affecting COVID-19 patients.
1. Mucormycosis or Zygomycosis (Black Fungus)
Mucormycosis (previously termed zygomycosis) or black fungus is a rare fungal infection caused by a group of fungi called mucormycetes. These are present naturally in the environment, particularly in soil, decaying fruits and vegetables, and other organic matter [5]. These fungi may affect individuals who:
– have some underlying health problems
– have a compromised immune system
– take medicines that lower the body’s ability to fight infections.
Recently, these fungi have started infecting people who are recovering or have recovered from COVID-19 [6]. It mainly affects the sinuses, brain, and lungs of such individuals.
If It’s Rare, Then What’s Causing The Current Surge?
A complex interplay of coronavirus infection, uncontrolled blood sugar levels, and immunosuppressive treatments has resulted in increased mucor infections in active, recovering, or recovered COVID-19 cases. [7]
Know the Dos and Don’ts
Dos [8]
– Monitor blood glucose levels. Fungal infections can occur even after weeks or months of recovery.
– Use clean, sterile water for humidifiers during oxygen therapy.
– Use steroids, antibiotics, and antifungals judiciously-consult a doctor regarding the need and the dose.
– Use masks if you are visiting dusty construction sites.
– Wear shoes, long trousers, long sleeve shirts, and gloves while handling soil (gardening) or manure.
– Maintain personal hygiene.
From Immunity Boosters To Personal Care Products, Check Out Our Coronavirus Prevention Range.
Don’ts [8]
– Don’t ignore the common signs such as blocked nose, pain, swelling, or redness in the eyes, facial or sinus pain, bluish-black discoloration of the facial skin, loosening and discoloration of teeth, or ulcers on the roof of the mouth among others. Take proper care.
– Never self-medicate, especially steroids.
– Consult an expert as soon as you see any symptom. This will ensure prompt treatment.
Read this article to find out about mucormycosis, its symptoms, treatment options, and more.
2. Candidiasis (White Fungus)
White Fungus or Candidiasis is an infection caused by a type of fungi called Candida. The infection may lead to the formation of white-creamy patches on affected areas and hence the name [9].
In COVID-19 patients, two commonly seen candidal infections include oral candidiasis (thrush) and candidemia. These can complicate the COVID-19 infection and even increase its spread rate, leading to high mortality [10]. Therefore, early diagnosis of candidal infections is important to establish effective treatment strategies.
– Oral Candidiasis: Also called thrush, is commonly seen in denture wearers, diabetics, and patients on steroid therapy. [11]
– Candidemia: A bloodstream infection with Candida that can occur in hospitalized COVID-19 patients receiving corticosteroid therapy. [12,13]
Symptoms Of Oral Candidiasis
Oral candidiasis may cause [11]:
-White patches on the inner cheeks, tongue, roof of the mouth, and throat
-Redness or soreness in the mouth
-Dry feeling in the mouth
-Loss of taste
-Pain while eating or swallowing
-Cracking and redness at the corners of the mouth
Symptoms Of Candidemia
Candidemia may cause [14]:
-Fever
-Chills
-Other symptoms can develop if the infection spreads to other parts of the body, such as the heart, brain, eyes, bones, or joints.
If you are recovering or have recovered from COVID-19 and noticed any of the above symptoms, consult a doctor IMMEDIATELY. Early diagnosis and treatment can reduce complications and offer better support.
Prevention And Treatment
Follow these preventive tips to prevent or treat white fungal infection in COVID-19 [11,15]:
– Maintain good oral hygiene.
– Rinse your mouth and brush your teeth, especially after using medicines such as corticosteroids.
– Doctor may prescribe taking antifungal medications such as fluconazole.
3. COVID-19 Associated Pulmonary Aspergillosis (CAPA)
Aspergillosis is a type of fungal infection caused by Aspergillus (mold fungus). This fungus affects people having [16]:
– a weakened immune system
– allergies
– infection in lungs or other organs
– lung diseases
COVID-19 may cause injury to the respiratory tract making people susceptible to the invasion of Aspergillus species fungal infection [17]. It is important to increase awareness about CAPA among the masses as this superinfection can act as an additional contributing factor to mortality in COVID-19 [18].
Symptoms Of CAPA:
CAPA can cause [19]:
– Fever
– Cough
– Shortness of breath
– Chest pain
– Coughing up blood
– Other symptoms can develop if the infection spreads from the lungs to other parts of the body
*CAPA can be difficult to diagnose because patients often have non-specific symptoms and testing typically requires a specimen from deep in the lungs.
Medical Management
To treat CAPA fungal infection in COVID-19, your doctor may prescribe [17]:
– Treatment with immunosuppressive medications should be discontinued or decreased wherever possible.
– Antifungal medicines such as Voriconazole, Isavuconazole, and Amphotericin B among others may help.
– Surgery may be needed in case of severe complications.
The Bottom Line
The overuse of steroids while treating COVID-19 or weakened immune system due to the intake of immunosuppressive medicines can partially explain the surge in the aforesaid fungal infections. These fungal infections can raid our body as our immune system is partially occupied or suppressed, adding to the burden of the COVID crisis. Knowledge and awareness is the only key to keep yourself at bay from any such infections.
Links to all e-books: https://www.1mg.com/coronavirus-covid19
(The article is written by Dr. Lipika Khurana, Medical Writer and reviewed by Dr. Sakshi Jain, Health Content Manager)
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References:
1. de Pauw BE. What Are Fungal Infections? Mediterr J Hematol Infect Dis. 2011; 3(1): e2011001. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3103258/
2.Hoenigl M. Invasive fungal disease complicating COVID-19: when it rains it pours Clin Infect Dis. 2020 Sep 5.
3. CDC. Fungal Diseases and COVID-19. https://www.cdc.gov/fungal/covid-fungal.html
4. CDC. Types of Fungal Diseases. https://www.cdc.gov/fungal/diseases/index.html
5. CDC. Mucormycosis. https://www.cdc.gov/fungal/diseases/mucormycosis/index.html
6. PIB. Stay Safe from Mucormycosis – a Fungal Complication being Detected in COVID-19 Patients Control Diabetes, Use Steroids Judiciously, Keep Good Hygiene, Don’t Self-Medicate. https://pib.gov.in/PressReleseDetailm.aspx?PRID=1718501
7.AIIMS COVID Portal. https://covid.aiims.edu/mucormycosis-in-covid-19/
8.ICMR. EVIDENCE BASED ADVISORY IN THE TIME OF COVID-19. https://www.icmr.gov.in/pdf/covid/techdoc/Mucormycosis_ADVISORY_FROM_ICMR_In_COVID19_time.pdf
9.After Black Fungus, Now Watch Out For White Fungus; Experts Explain Symptoms. The Better India. https://www.thebetterindia.com/255481/black-fungus-white-fungus-symptoms-treatment-cure-prevention-fortis-jaslok-hospital-covid-19-coronavirus-brain-nails-patches-lung-soil-candida-information-vid01/
10.CDC. Candidiasis. https://www.cdc.gov/fungal/diseases/candidiasis/index.html
11.Jerônimo LS, Esteves Lima RP, Suzuki TYU, Discacciati JAC, Bhering CLB. Oral Candidiasis and COVID-19 in Users of Removable Dentures: Is Special Oral Care Needed? Geneology. https://www.karger.com/Article/FullText/515214
12.CDC. Invasive Candidiasis. https://www.cdc.gov/fungal/diseases/candidiasis/invasive/index.html
13.Riche CVW, Cassol R, and Pasqualotto AC. Is the Frequency of Candidemia Increasing in COVID-19 Patients Receiving Corticosteroids? J Fungi (Basel). 2020 Dec; 6(4): 286. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7712895/
14.CDC. Symptoms of Invasive Candidiasis. https://www.cdc.gov/fungal/diseases/candidiasis/invasive/symptoms.html
15.CDC. Treatment for Invasive Candidiasis. https://www.cdc.gov/fungal/diseases/candidiasis/invasive/treatment.html
16. CDC. Aspergillosis. https://www.cdc.gov/fungal/diseases/aspergillosis/index.html
17.Koehler P, Bassetti M, Chakrabarti A, et al. Defining and managing COVID-19-associated pulmonary aspergillosis: the 2020 ECMM/ISHAM consensus criteria for research and clinical guidance. Lancet Infect Dis. Published online December 14, 2020. doi:10.1016/S1473-3099(20)30847-1.
18.Koehler P, Bassetti M, and Chakrabarti A. Defining and managing COVID-19-associated pulmonary aspergillosis: the 2020 ECMM/ISHAM consensus criteria for research and clinical guidance. Lancet. https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30847-1/fulltext
19.CDC. Symptoms of Aspergillosis.
https://www.cdc.gov/fungal/diseases/aspergillosis/symptoms.html