VIVEKANAND KENDRA

ZILLA PARISHAD
VIDYALAYA
PORT MOUT
BIOLOGY INVESTIGATORY
PROJECT
2021- 22

“MUCORMYCOSIS
(BLACK FUNGUS):
THE INFECTION
LINKED TO COVID-
19”
VIDYUT KUMAR YADAV
CLASS 12th
 CERTIFICAT
E

This is to certify that this biology project

entitled “Mucormycosis (Black fungus):
The infection linked to COVID-19” has
satisfactorily completed by Vidyut Kumar
Yadav of class XII of V.K.Z.P.V. Port-Mout
in the academic year 2021-2022.
Teacher’s signature Examiner’s signature

ACKNOWLEDGEMENT
I would like to express my special thanks
of gratitude to my Principal who is also my
Biology teacher Shri. S. RAJKUMAR who
gave me the golden opportunity to do this
wonderful project on the topic
“Mucormycosis (Black Fungus): The
infection linked to COVID- 19” , which also
helped me in doing a lot of research and I
came to know about so many new things.
Secondly, I would also like to thank my
parents and friends who helped me a lot
in finalizing this project within the limited
time frame.
VIDYUT KUMAR YADAV
 CONTENT
 OBJECTIVE
 INTRODUCTION
 HOW IT IS CAUSED?
 TYPES OF MUCORMYCOSIS
 HOW DOES IT AFFECT?
 HOW IT IS LINKED TO COVID
- 19?
 INDIA AND MUCORMYCOSIS
 TREATMENT of mucormycosis
 CONCLUSION
 BIBLIOGRAPHY
 OBJECTIVE
The main objective of this
biology project is to know and
research about mucormycosis
commonly known as black
fungus and its linkage with
corona virus. How it is caused
and how it can be cured?
 INTRODCTION

What Is Mucormycosis?
Mucormycosis, also known as black fungus, is a
rare but dangerous infection. It's caused by a
group of molds called mucormycetes and often
affects the sinuses, lungs, skin, and brain.
You can inhale the mold spores or come into
contact with them in things like solid, rotting
produce or bread, or compost piles. Also these
fungi are common in solid, decomposing organic
matter (such as rotting fruit and vegetables) and
animal manure, but usually do not affect people.

Who Is at Risk?
The infection can happen to anyone at any
age. Most people will come into contact with
the fungus at some point in their everyday
lives. But you're more likely to get sick if
you have a weakened immune
system because of a medication you're
taking or because you have a health
condition like:
 Diabetes, especially when it isn't under
control
 HIV or AIDS
 Cancer
 Organ transplant
 Stem cell transplant
 Neutropenia (low white blood cell count)
 Long-term steroid use
 Injected drug use
 High levels of iron in your body
(hemochromatosis)
  Bad health from poor nutrition
 Uneven levels of acid in your body
(metabolic acidosis)
 Premature birth or low birth weight
 It's also more likely if you have a skin
injury like a burn, cut, or wound. And
cases have been reported in people with
COVID-19.
 Mucormycosis isn't contagious.
Mucormycosis is usually rare, affecting fewer than
2 people per million people each year in San
Francisco,[but is now ~80 times more common in
India. People of any age may be affected,
including premature infants. The first known case
of mucormycosis was possibly one described
by Friedrich Küchenmeister in 1855. The disease
has been reported in natural disasters; 2004
Indian Ocean tsunami and the 2011 Missouri
tornado.
 HOW IT IS CAUSED?
Mucormycosis is a fungal infection caused by fungi in
the order mucorales.In most cases it is due to an
invasion of the genera rhizopus and mucor, common
bread molds. Most fatal infections are caused
by rhizopus oryzae. It is less likely due to lichtheimia,
and rarely due to apophysomycesb others
include cunninghamella, mortierella, and saksenaea.

The fungal spores are in the environment, can be

found on for instance moldy bread and fruit and are
breathed in frequently, but cause disease only in some
people. In addition to being breathed in to be
deposited in the nose, sinuses and lungs, the spores
can also enter the skin via blood or directly through a
cut or open wound, or grow in the intestine if eaten.
Once deposited, the fungus grows branch-like

filaments which invade blood vessels, causing clots

to form and surrounding tissues to die. Other

reported causes include contaminated wound
dressings. Mucormycosis has been reported
following the use of Elastoplast and the use
of tongue depressors for holding in place
intravenous catheters, Outbreaks have also
been linked to hospital bed sheets, negative-
pressure rooms, water leaks, poor ventilation,
contaminated medical equipment, and
building works.
 Types of Mucormycosis
RHINO – ORBITO – CEREBRAL
. Rhino-orbito-cerebral
mucormycosis(ROCM) is an invasive
fungal infection that usually occurs in
immunocompromised
patients and sometimes
presents as orbital apex
syndrome(OAS) initially.
It is rapidly fatal without an early diagnosis
and treatment.
PULMONARY MUCORMYCOSIS
Pulmonary mucormycosis is an
opportunistic pulmonary
fungal infection from a
fungus belonging to the
order Mucorales
It has to be
distinguished from the related
counterpart invasive pulmonary
aspergillosis (IPA) as modern first-line
antifungals typically used for aspergillosis
lack activity against fungi causing
mucormycosis.
ON THE BASIS OF PARTS OF BODY
IT IS CLASSIFIED AS 4 TYPES
Sinuses and brain (rhinocerebral): Most
common in people with
poorly
controlled diabetes and in
people who have had
a kidney transplant.
Stomach and intestine(gastro
intestinal) : More common among young
premature and low birth
weight infants, who have
had antibiotics, surgery,
or medications that
lower the body's ability
to fight infection.
Skin (cutaneous) : After a
burn, or other skin injury, in
people with leukaemia poorly
controlled diabetes, Graft-
versus-host disease, HIV
and intravenous drug use.

Widespread (disseminated) : When the

infection spreads to other organs via the blood.
How does it
affect?
 Most people are frequently exposed
to Mucorales without developing the
disease. Mucormycosis is generally
spread by, or getting spores by, or
getting spores of mold of the
Mucorales type in an open wound. It
is not transmitted between people.
The precise mechanism by which
diabetics become become
susceptible is unclear. In vivo, a high
sugar alone does not permit the
growth of the fungus, but acidosis
alone does not permit the growth of
the fungus, but acidosis alone does.
People with high sugars frequently
have higher iron levels, also does.
MEDICAL REASON FOR BLACK FUNGUS
INFECTION
According to medical experts, the main cause
of black fungus (mucormycosis) is steroid
misuse during COVID treatment. Black
fungus (mucormycosis) primarily affects people
who have health problems or who take
medications that reduce the body's ability to
fight germs and illness.

HOW IT IS LINKED TO
COVID – 19?
Mucormycosis can occur any time after
COVID-19 infection, either during the hospital
stay or several days to a couple of weeks
after discharge.
“The COVID-19 causes favourable alteration
in the internal milieu of the host for the fungus
and the medical treatment given, unwittingly
also abets fungal growth. COVID-19
damages the airway mucosa and blood
vessels. It also causes an increase in the
serum iron which is very important for the
fungus to grow. Medications like steroids
increase blood sugar. Broad-spectrum
antibiotics not only wipe out the potentially
pathogenic bacteria but also the protective
commensals. Antifungals like Voriconazole
inhibit Aspergillosis but Mucor remains
unscathed and thrives due to lack of
competition. Long-term ventilation reduces
immunity and there are speculations of the
fungus being transmitted by the humidifier
water being given along with oxygen. All the
above make for a perfect recipe for
mucormycosis infection.
Can there be other fungal infections in COVID
19 patients?
Some patients can have COVID-19 and a fungal
infection at the same time. People with
severe COVID-19, such as those in an intensive
care unit (ICU), are particularly vulnerable to
bacterial and fungal infections. The most
common fungal
infections in patients with COVID-19 include
aspergillosis or invasive candidiasis.

OTHER POST COVID INFECTION

WHITE FUNGUS: The White Fungus is a fungal
infection that occurs mainly among immunocompromised
people this includes COVID-19 positive people, those with
uncontrolled diabetes and people on a high dose of steroids.

YELLOW FUNGUS: Yellow fungus is a dangerous

disease that begins internally and a person should seek
medical attention as soon as he or she observes any
symptoms. It is a life-threatening infection that begins
internally. The yellow fungus also can cause pus leakage
and poor wound healing, starvation and organ failure, and
sunken eyes due to necrosis in severe cases.

GREEN FUNGUS: Green fungus, also known as

Aspergillosis, is an infection caused by Aspergillus, a
common mold that lives indoors and outdoors. People
can get aspergillosis by breathing in microscopic
Aspergillus spores from the environment. .
 INDIA AND
MUCORMYCOSIS

During
the CO VID
-19 pandemic in India, the disease is making another
important health emergency. The Indian government
reported that more than 11,700 people were receiving
care for mucormycosis as of 25 May 2021. Many
Indian media outlets called it "black fungus" because
of the black discoloration of dead and dying tissue the
fungus causes. Even before the COVID-19 pandemic,
rates of mucormycosis in India were estimated to be
about 70 times higher than in the rest of the world.

AN EPIDEMIC WITHIN A PANDEMIC

The emergence of black fungus is

actually a black swan event which
became obvious in hindsight. Although it
is described as ‘rare’ in western
literature, India in the pre-COVID era
contributed to 40 percent of the global
burden with an estimated 140 cases of
Mucormycosis per million populations.
Due to its rapidly growing number of cases
many Indian state governments have
declared it an epidemic.

The COVID-19 pandemic has left many people

around the world with weakened immune systems—
the ideal conditions for the black fungus looking for a
new host. India is currently at the center of that

perfect storm

According to the World Health Organization, India

has reported over 27 million cases with more than
300,000 deaths as of May 26. However, Desai says
that since census statistics tend not to be up to date,
the. Numbers are probably much higher.
 List of most infected Indian states
As on 10th June 2021

 Maharashtra: The state has 1,500 cases of mucormycosis and

90 deaths due it.

 Gujarat: As many as 1,163 cases of mucormycosis have been

detected and 61 people have died due to it.

 Madhya Pradesh: The state has 575 cases of and 31 deaths

due to mucormycosis.

 Haryana: As many as 268 cases, eight deaths due to

mucormycosis have been reported in Haryana.

 Delhi: The national capital has registered 203 cases of

mucormycosis and one death due to it.

 Uttar Pradesh: The state has registered 169 cases of

mucormycosis and eight deaths due to it.

 Bihar: As many as 103 cases, 2 deaths due to mucormycosis

have been registered in Bihar.

 Chhattisgarh: Mucormycosis has been detected in 101 people

and one person has died in the state because of it.

 Karnataka: While 97 cases of mucormycosis have been

reported in this southern state, the number of people who died

due to it stands at zero, according to official data.

 Telangana: As many as 90 cases of mucormycosis have been

detected here and 10 deaths have also been recorded.

INFECTION IN ANDAMAN & NICOBAR

ISLANDS

There were zero cases of black fungus in Andaman and

Nicobar Islands but the union territory as on 21st June 2021

has 121 active COVID-19 cases, of which 117 are in South

Andaman district while the rest four in North and Middle

Andaman district, the official said, the Nicobar district is

now coronavirus free.

 TREATMENT OF
MUCORMYCOSIS
MEDICATION
Once mucormycosis is suspected, Amphotericin
B at an initial dose of 1mg is initially given slowly
over 10-15 minutes into a
vein, and then given as a
once daily dose according
to body weight for the next
14 days. It may need to be
continued for
longer. Isavuconazole and Posaconazole are
alternatives
SURGERY
Surgery can be very drastic,
and in some cases of
disease involving the nasal
cavity and the brain, removal
of infected brain tissue may
be required. Removal of the palate, nasal cavity,
or eye structures can be very disfiguring.
OTHER CONSIDERATIONS
The disease must be monitored carefully for any
signs of reemergence. Treatment also requires
correcting sugar levels and improving neutrophil
counts. Hyperbaric oxygen may be considered as
an adjunctive therapy because higher
oxygen pressure increases the ability
of neutrophils to kill the fungus .The efficacy of
this therapy is uncertain.
A LIST OF DOs AND DON’Ts AS PER THE
ICMR GUIDELINES:

DO’s
 Control hyperglycemia or high blood sugar
levels
 Keep an eye on blood glucose level post
Covid-19 discharge and also in diabetics.
 Judicious use of steroid: correct timing,
correct dose and duration.
 Use clean, sterile water for humidifiers during
oxygen therapy.
 Use clean, sterile water for humidifiers during
oxygen therapy

DON’Ts
 Do not miss or ignore warning signs and
symptoms.
 Do not consider all the cases with blocked
nose as cases of bacterial sinusitis,
particularly in the context of
immunosuppression and/or COVID-19
 patients on drugs that weaken the immune
system.
 Don’t hesitate to seek “aggressive”
investigations, as directed by medical experts
(KOH staining & microscopy, culture, MALDI-
TOF), key for detecting the infection.
 Do not lose crucial time to initiate treatment
for mucormycosis
 CONCLUSION
Although considered to be a rare infection, mucormycosis
(zygomycosis) has emerged as the second most common invasive
mould infection. Despite the advent of newer antifungal agents,
mortality rate of mucormycosis remains exceedingly high. . The
COVID-19 pandemic has left many people around the world with
weakened immune systems—the ideal conditions for the black
fungus looking for a new host. India is currently at the center of
that perfect storm. Several other post covid infection like white
fungus, yellow fungus, green fungus were also reported in
several parts of the country. Successful management of
mucormycosis requires early diagnosis, reversal of underlying
predisposing risk factors, surgical debridement and prompt
administration of active antifungal agents. However,
mucormycosis is not always amenable to cure. There are
challenging obstacles that lead to difficulties in management of
amphotericin B. Overall it is well said:

“PREVENTION IS BETTER THAN CURE”

 BIBLIOGRAPHY
 https://www.google.com/

 https://www.wikipedia.org/

 https://gulfnews.com/

 https://www.bbc.com/

 https://www.medicoverhospitals.in/

 https://www.sciencephoto.com/