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What is flesh-eating fungal infection Mucormycosis, which has claimed 34 lives in Gujarat?

Gujarat has witnessed a total of 34 deaths in 14 major hospitals caused due to flesh-eating fungal infection mucormycosis in the last 6 months. Those who are vulnerable include people with weak immune systems and diabetic post-Covid patients mostly above the age of 50. Earlier, the state government had issued an advisory to healthcare professionals saying that the infection is rare and has a mortality rate of 50%. 

Mucormycosis (sometimes called zygomycosis) is a serious but rare fungal infection caused by a group of molds called mucormycetes.  These fungi live throughout the environment, particularly in soil and in decaying organic matter, such as leaves, compost piles, or rotten wood.

People get mucormycosis by coming in contact with the fungal spores in the environment. For example, the lung or sinus forms of the infection can occur after someone breathes in spores. These forms of mucormycosis usually occur in people who have health problems or take medicines that lower the body’s ability to fight germs and sickness. Mucormycosis can also develop on the skin after the fungus enters the skin through a cut, scrape, burn, or other types of skin trauma.

Types of mucormycosis

  • Rhinocerebral (sinus and brain) mucormycosis is an infection in the sinuses that can spread to the brain. This form of mucormycosis is most common in people with uncontrolled diabetes and in people who have had a kidney transplant.
  • Pulmonary (lung) mucormycosis is the most common type of mucormycosis in people with cancer and in people who have had an organ transplant or a stem cell transplant.
  • Gastrointestinal mucormycosis is more common among young children than adults, especially premature and low birth weight infants less than 1 month of age, who have had antibiotics, surgery, or medications that lower the body’s ability to fight germs and sickness.
  • Cutaneous (skin) mucormycosis: occurs after the fungi enter the body through a break in the skin (for example, after surgery, a burn, or other types of skin trauma). This is the most common form of mucormycosis among people who do not have weakened immune systems.
  • Disseminated mucormycosis occurs when the infection spreads through the bloodstream to affect another part of the body. The infection most commonly affects the brain but also can affect other organs such as the spleen, heart, and skin.

Symptoms 

The symptoms of mucormycosis depend on where in the body the fungus is growing. Contact your healthcare provider if you have symptoms that you think are related to mucormycosis.

Symptoms of rhinocerebral (sinus and brain) mucormycosis include:

  • One-sided facial swelling
  • Headache
  • Nasal or sinus congestion
  • Black lesions on the nasal bridge or upper inside of the mouth that quickly become more severe
  • Fever

Symptoms of pulmonary (lung) mucormycosis include:

  • Fever
  • Cough
  • Chest pain
  • Shortness of breath

Cutaneous (skin) mucormycosis can look like blisters or ulcers, and the infected area may turn black. Other symptoms include pain, warmth, excessive redness, or swelling around a wound.

Symptoms of gastrointestinal mucormycosis include:

  • Abdominal pain
  • Nausea and vomiting
  • Gastrointestinal bleeding

Disseminated mucormycosis typically occurs in people who are already sick from other medical conditions, so it can be difficult to know which symptoms are related to mucormycosis. Patients with disseminated infection in the brain can develop mental status changes or coma.

How can one reduce the chances of getting infected?

There is no vaccine to prevent mucormycosis but some actions are recommended to lower the risk of infection.

  • Protect yourself from the environment- 
    • Try to avoid areas with a lot of dust like construction or excavation sites. If you can’t avoid these areas, wear an N95 respirator (a type of face mask) while you’re there. 
    • Avoid direct contact with water-damaged buildings and flood water after hurricanes and natural disasters.
    • Avoid activities that involve close contact to soil or dust, such as yard work or gardening. If this isn’t possible,
      • Wear shoes, long pants, and a long-sleeved shirt when doing outdoor activities such as gardening, yard work, or visiting wooded areas.
      • Wear gloves when handling materials such as soil, moss, or manure.
      • To reduce the chances of developing a skin infection, clean skin injuries well with soap and water, especially if they have been exposed to soil or dust.
  • Antifungal medication- If you are at high risk for developing mucormycosis (for example, if you’ve had an organ transplant or a stem cell transplant), your healthcare provider may prescribe medication to prevent mucormycosis and other mold infections. Doctors and scientists are still learning about which transplant patients are at highest risk and how to best prevent fungal infections.

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