What do you mean by a mutilated check?

India: Dangerous fungal infection in corona patients

The pictures of people who have become infected with the "black fungus" are frightening (For this reason they are not published in this article - editor's note). Often the faces are mutilated by operations. The disease mostly affects the sinuses or the lungs. In India in particular, doctors have to make the diagnosis more and more frequently.

People who are immunocompromised are particularly affected. This also includes patients who are currently going through or have survived a COVID-19 infection. Mucormycosis is a rare infectious disease caused by contact with the Mucor mold. Especially now, when India is battling the second corona wave, mucormycosis, which is often fatal, is another factor.

The situation is very serious, explains Prof. Oliver Cornely from the European Center of Excellence for Invasive Fungal Infections. "Colleagues in India report that the number of cases of mucormycosis has increased very, very sharply and that the large hospitals are now diagnosing this disease in a patient every other day." It is not known exactly how many infected people there are.

Like a horror movie

The fungi mainly attack body surfaces. However, this does not only mean the skin, but also internal surfaces where air comes into contact. The spores of the mold are inhaled and get into the paranasal sinuses and the deeper airways.

Around 1.5 million people die of fungal infections worldwide every year

"In the paranasal sinuses, the fungus grows through the mucous membrane into the bones," explains Cornely. "It can also grow unchecked through the bone. Then, anatomically, it gets to where the eye is, the eye socket, the muscles and the nerves."

In the worst case, surgeons have to remove the entire eye to save the patient's life. Only through such a radical operation can they get rid of the diseased tissue.

"It can also happen that the fungus breaks through the bone and goes straight to the brain," says Cornely. That is almost always fatal. Depending on how quickly and how intensively the patient is treated, the mortality rate is 50 to 90 percent.

Hard to stop

The first symptoms are often rather unspecific: red eyes and red nose. In the further course, however, it can also lead to bloody or black nasal discharge, fever and shortness of breath. It is important to treat mucormycosis as early as possible. However, the disease can usually only be stopped by surgical intervention.

Often, however, it takes too long before doctors can identify the disease and take action. "Surgeons and infectiologists in India are certainly very experienced when it comes to mucormycosis. But even they don't usually have a new case every day or every other day." But that's the current situation, adds Cornely.

Mucormycosis is being diagnosed with increasing frequency in India

Sometimes the patients would be mutilated by an operation. "If the fungus grows from the sinuses into the eye, for example, the surgeons have to remove parts of the face," says Cornely, describing the gruesome procedure. "It destroys any tissue that is in its way. Blood vessels are also part of it. As a result, they can no longer transport drugs to the right place." So surgery is usually the method of choice.

Diabetics are particularly at risk

Diabetics are particularly susceptible to the fungal disease, and their number is particularly high in India. Diabetes is sometimes referred to as an epidemic, says Cornely. "At great risk of contracting mucormycosis is people with diabetes that has never been treated and is still untreated."

Diabetes weakens the immune system so that the body has little to counteract the fungal spores. In a healthy person, the microscopic spores inhaled are neutralized by the body's defenses, explains Cornely.

But this is not only less powerful in a diabetic: in the case of untreated diabetes, the mucous membrane cells also form an environment that is the receptor for the Mucor. "It can then, as it were, hold on to there. Once it has done so, it immediately begins to grow and the spore becomes a thread-like fungus," says Cornely.

First corona, then a fungal infection

The fact that mucormycosis is increasing in India in times of Corona is due, among other things, to the fact that a COVID-19 infection also weakens the immune system. The same applies to the administration of cortisone: Although it inhibits inflammation, it also inhibits the body's own defenses. It is so easy for intruders.

The fungus can spread easily in people with weakened immune systems

"With a corona infection, the airways are usually sore, says Cornely. The epithelial layers, which otherwise form a defense, are destroyed." These are ideal conditions for the "black mushroom".

"These mushrooms don't actually belong in humans. Their ecological task is rather to break down wood, plants and dead bodies," says Cornely. The fungus can be found in nature: in the earth, for example, but also in spoiled food or in rotten fruit.

"Perhaps," speculates the infectiologist, "it also has something to do with the fact that the climatic conditions in Southeast Asia are different from those in Germany, for example, where one or two people in a million are affected each year. It could also have an influence that the amount of pathogens people are exposed to is greater in these countries. "

In addition, there are poor hygienic conditions, poverty and often cramped conditions. This can also promote the development of various diseases. "Corona," says expert Cornely, "now brings out diseases that are otherwise rather rare, and this includes mucormycosis."

  • Eerily beautiful mold

    A mushroom arises

    A mold initially grows in tiny threads - which the human eye can only see under a microscope. This thread network is called mycelium. Molds only develop the typical furry coating when they grow out of this nutrient medium into the air. They feel particularly comfortable where they can find water, oxygen or a source of carbon - such as sugar.

  • Eerily beautiful mold

    Flower-like heads

    The mold gets its bright color from the spores. They form on the heads of the furry threads. When enlarged, the spore heads look like flowers. The color - whether yellow, green, brown, black or red mold - is ultimately mostly due to the fungus's nutrient base.

  • Eerily beautiful mold

    A thick lawn

    The so-called spore carriers mature in the individual capsules in the flower-like spore heads. A slight breeze is enough to simply carry it away. The mold continues to grow and spreads outwards in a circular manner. Depending on the age and severity of the infestation, a dense lawn of mold forms.

  • Eerily beautiful mold

    Not always harmful

    Despite their bad reputation, many molds are even useful: the so-called saprophytes decompose organic material - such as rotten wood - and convert it into nutrients that can then be used by plants. In addition, mold itself is also the basic food source for some insects and arachnids.

  • Eerily beautiful mold

    Good mold

    Some of the substances produced by mold, such as penicillin, are even used in the pharmaceutical industry - it is a natural antibiotic made from the mold Penicillium. Mushrooms are also used in the production of food - for delicious air-dried salami or blue cheese, for example.

  • Eerily beautiful mold

    Molds as parasites

    Much more often, however, molds are talked about as parasites when they attack plants, animals or people and make them sick. There are stubborn fungi, especially on food, that prefer dry environments that are heat-stable and resistant to preservatives. They can have unpleasant consequences for people.

  • Eerily beautiful mold

    Unhealthy in the long run

    However, molds rarely cause infections. Allergies are much more common with prolonged contact. Difficulty breathing, asthma, neurodermatitis, migraines and headaches, for example, can occur as a result of living with a mold as a roommate for too long.

  • Eerily beautiful mold

    Hazardous gases

    Mycotoxins, poisons formed by fungi, are particularly harmful and even carcinogenic. Over 200 species of fungi are known that can form such gases in food and feed or indoors. This happens either through food intake or the toxins adhere to the spores and are carried through the air and inhaled.

  • Eerily beautiful mold

    Is it rubbish?

    But do you really have to throw away an apple as soon as it has a brown spot or is it enough to simply cut away the spot? The fact is: one should refrain from eating moldy food! Whether jam, bread, nuts, fruit or cheese: As soon as it becomes moldy, the whole food should be disposed of and not just the visible mold removed.

  • Eerily beautiful mold

    Prevent pests

    So that it doesn't get that far in the first place, food should be stored dry and cool and consumed as quickly as possible after opening the packaging. In addition, the organic waste should not be in the kitchen for too long and the compost heap should not be placed directly next to the front door.

    Author: Kathrin Witsch