Mucormycosis in cancer patients - an emerging threat

The incidence of ‘black fungus’ has increased manifold during the ‘second wave’ of covid-19. There is a lot of panic and anti-fungals are in high demand and not easily available currently. So what exactly is this ‘black fungus’? Is it a novel infection like the Covid -19? Does it affect only covid patients or even others are at risk? How deadly is it?

Recently, Mucormycosis has caught attention due to spike in its incidence in post covid cases, however for Oncologists and cancer patients the risk has always been there. Among cancer patients, the most commonly affected are the hematological cancer or more commonly known as ‘blood cancer’ patients and the bone marrow transplant recipients. Patients receiving chemotherapy and advanced stage cancer patients are also at risk for mucormycosis.

Mucormycosis, also known as zygomycosis and commonly called black fungus, is an aggressive fungal infection, generally affecting people with low immunity. It most commonly infects the nose, the nasal passage and sinuses and ultimately spreads to eyes and the brain. Usually it doesn’t affect the lungs, food pipe or stomach, but that too can happen in the later stages.

It generally spreads by breathing in, eating food contaminated by, or getting spores of this mould in an open wound. It is not transmitted from person to person contact. The spores of this fungus are present in the air, in decaying fruits, vegetables, leaves, and excreta, but it usually does not affect people. However, it can infect persons with compromised immune status due to any underlying cause like diabetes, cancer, recipients of organ transplants, iron overload, long-term steroids or immunosuppressant use, and HIV/AIDS.

Infection usually begins in the mouth or nose and thereafter may enter the brain via the eyes.

There can be pain in the face, numbness, fever, loss of smell, a blocked nose or runny nose and may have swelling of one side of face and progressing “black coloured lesions” in the nose or palate. One eye may look swollen and bulging, and vision may be blurred.

Mucormycosis infection spreads very rapidly and can involve sinuses, eye sockets and brain in a few weeks. It is fatal in about half of the cases when the infection is limited to the sinuses and almost in all cases when it has spread further in the body. An early diagnosis and prompt treatment is very important for successful results. Diagnosis is by biopsy and culture, with CT/MRI scan to help determine the extent of disease. Treatment is generally with surgical debulking and antifungal medicines. Cancer patients must practice the following things to avoid getting infected with black fungus:

  • Always wear a face mask.
  • Avoid dust exposure.
  • Avoid contact with water-damaged buildings.
  • Protect your skin from trauma while gardening or working in farms.

Anybody suffering from or having recently recovered from cancer, if experiencing any of the symptoms suggestive of 'black fungus' should consult an Oncologist without delay as it is always better to be safe than sorry.

Dr. Abhishek Gulia
Senior Conultant
Department of Radiation Oncology
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