How Black Fungus Could Be Impacting COVID-19

This week, a scary, new term has dominated much of the COVID-19 conversation. It's called mucormycosis or "black fungus," and you've likely heard more about the potentially deadly infection due to its increasing prevalence in India, where coronavirus cases are still skyrocketing. Specifically, the country is reporting a growing number of mucormycosis diagnoses in people who currently have or recently recovered from COVID-19 infections. A few days ago, Maharashtra's health minister said that more than 2,000 mucormycosis cases have been reported in the state alone, according to the Hindustan Times. While black fungus infections are relatively rare, "if uncared for [it] may turn fatal," according to an advisory from the Indian Council of Medical Research and India's Health Ministry. At the time of publication, the black fungus infection had killed at least eight people in Maharashtra. (Related: How to Help India During the COVID-19 Pandemic No Matter Where You Are In the World)

Now, if the world's learned anything from this pandemic, it's that just because a condition emerges across the globe, doesn't mean it can't make its way to your own backyard. In fact, mucormycosis "is already here and has always been here," says Aileen M. Marty, M.D., an infectious disease specialist and professor at Florida International University's Herbert Wertheim College of Medicine.

But don't panic! The infection-causing fungi are often found in decaying organic matter and in the soil (i.e. composts, rotten wood, animal dung) as well as in floodwater or water-damaged buildings after natural disasters (such as was the case following Hurricane Katrina, notes Dr. Marty). And remember, black fungus is rare. Here's what you need to know about mucormycosis.

What Is Black Fungus?

Mucormycosis, or black fungus, is a serious but rare fungal infection caused by a group of molds called mucormycetes, according to the Centers for Disease Control and Prevention (CDC). "Fungi that cause mucormycosis are present [throughout] the environment," explains Dr. Marty. "[They're] especially common in decaying organic substrates, including bread, fruits, vegetable matter, soil, compost piles, and animal excreta [waste]." Quite simply, they're "everywhere," she says.

Although pervasive, these disease-causing molds mainly affect people who have health problems (i.e. are immunocompromised) or those who are taking immunosuppressive medications, according to the CDC. So how do you develop an infection from black fungus? Usually by breathing in the teeny, tiny fungal spores that the mold releases into the air. But you can also get the infection on the skin via an open wound or burn, adds Dr. Marty. (Related: Here's Everything You Need to Know About Coronavirus and Immune Deficiencies)

The good news: "It can only infiltrate, grow, and cause disease in a tiny percentage of people unless you receive an overwhelming 'dose' of infection at one time" or it enters through "a traumatic injury," explains Dr. Marty. So, if you're generally in good health and don't have an open sore that comes into direct contact with the mold or breathe in a boatload of spores while, say, camping on top of mold-ridden soil (although, that's hard to know since they're so damn small), your odds of becoming infected are fairly low. The CDC reports it usually investigates one to three cases of clusters (or small outbreaks) of black fungus linked to certain groups of people, such as those who have an organ transplant (read: are immunocompromised) each year.

What Are the Symptoms of Black Fungus, and How Is It Treated?

Symptoms of mucormycosis infections can range from headache and congestion to fever and shortness of breath depending on where in the body the black fungus is growing, according to the CDC.

• If your brain or sinus becomes infected, you may experience nasal or sinus congestion, headache, one-sided facial swelling, fever, or black lesions on the nasal bridge in between your eyebrows or upper inside of the mouth.

• If your lungs become infected, you might also deal with fever in addition to cough, chest pain, or shortness of breath.

• If your skin becomes infected, symptoms can include blisters, excessive redness, swelling around a wound, pain, warmth, or a black infected area.

• And, lastly, if the fungus infiltrates your gastrointestinal tract, you may experience abdominal pain, nausea and vomiting, or gastrointestinal bleeding.

When it comes to the treatment of mucormycosis, physicians usually call upon prescription antifungal medicines that are administered orally or intravenously, according to the CDC. (FYI — this does not include all antifungals, such as the fluconazole your ob-gyn prescribed for that yeast infection.) Oftentimes, patients with black fungus have to undergo surgery to remove infected tissue.

Why Are There So Many Black Fungus Cases In India?

First, understand that "there is no direct relationship" between mucormycosis or black fungus and COVID-19, emphasizes Dr. Marty. Meaning, if you contract COVID-19, you're not necessarily going to become infected with black fungus.

However, there are a few factors that could explain the cases of black fungus in India, says Dr. Marty. The first is that COVID-19 causes immunosuppression, which, again, makes someone increasingly more susceptible to mucormycosis. Similarly, steroids — which are typically prescribed for severe forms of coronavirus — also suppress or weaken the immune system. Diabetes and malnourishment — which are particularly prevalent in India — are likely also at play, says Dr. Marty. Both diabetes and malnutrition impair the immune system, thus opening patients up to a fungal infection such as mucormycosis. (Related: What Is Comorbidity, and How Does It Affect Your COVID-19 Risk?)

Essentially, "these are opportunistic fungi that are taking advantage of the immunosuppression caused by the SARS-CoV-2 virus coupled with the use of steroids and the other issues mentioned above in India," she adds.

Should You Be Worried About Black Fungus In the U.S.?

Mucormycosis is already in the U.S. — and has been for years. But there's no immediate cause for worry, as, again, "these fungi aren't harmful to most people" unless you have a weakened immune system, according to the CDC. In fact, they're so ubiquitous in the environment that the U.S. National Library of Medicine upholds that "most people come in contact with the fungus at some time."

All you can really do is know the specific infection symptoms to look out for and take the proper precautions to stay healthy. Do everything you can to "avoid getting COVID-19, eat right, exercise, and get plenty of sleep," says Dr. Marty.

The information in this story is accurate as of press time. As updates about coronavirus COVID-19 continue to evolve, it's possible that some information and recommendations in this story have changed since initial publication. We encourage you to check in regularly with resources such as the CDC, the WHO, and your local public health department for the most up-to-date data and recommendations.