Mucormycosis Among Cancer Patients: Who Are At Greater Risk For Black Fungus Infection?

The Black fungus, also known as mucormycosis, has been a pre-existing disease even before the advent of COVID-19, though very few numbers were reported annually. People who are immunocompromised are more vulnerable to developing the black fungus infection. The patients reporting mucormycosis as a post-covid complication are largely the ones who have immunosuppressing conditions like an organ transplant history, uncontrolled diabetes, and cancer. These health conditions have predisposed the patients to this infection, said Dr. S M Shuaib Zaidi, Senior Consultant, Surgical Oncology, Indraprastha Apollo Hospital, New Delhi.

Among cancer patients, mucormycosis most commonly affects haematological cancer or more commonly known as 'blood cancer' patients and the bone marrow transplant recipients, according to Dr. Zaidi.

"Patients receiving chemotherapy and advanced stage cancer patients are also at risk for mucormycosis. 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," he added.

Why Black fungus is affecting COVID patients more?

The Black fungus or mucormycosis is affecting COVID patients more due to prolonged administration of steroids and subsequent immunocompromised state of health. It is reported more in patients who have diabetes, renal failure, cancer or who have undergone kidney/liver transplant and in patients who have been administered steroids for a long time, according to Dr. Zaidi.

"The viruses, as part of their replication cycle, suppress the immune system leading to the immune system not being able to clear /fight any other form of bacteria or fungi. The most famous example of this is HIV, of course, which causes long-term immune suppression. But other viruses do this on a much shorter timescale i.e., the immune system is only slightly suppressed for a few days or weeks while the virus is there," he explained.

Are you aware of the symptoms of Mucormycosis?

Patients suffering from the fungal infection typically have symptoms of stuffy and bleeding nose; swelling and pain in the eye; drooping of eyelids; blurred vision and in some cases loss of vision. There could be black patches of skin around the nose. Other possible symptoms include: 

• Headache
• Double vision
• Loosing teeth
• Black patch on palate
• Facial pain
• Nasal congestion- brown colour discharge
• Loss of vision or pain in the eyes
• Swelling in cheeks and eyes
• Black crusts in the nose
• Coughing
• Bloody vomits
• Altered mental status

Mucormycosis in Covid patients: The mechanism of infection explained

As Dr. Zaidi stated, patients who have been on immunosuppressant drugs due to cancer treatments or organ transplants are more susceptible to this fungal infection. Other factors are usage of immune suppressant drugs, people who have undergone organ transplant, and even in severe covid cases. The expert further elaborated on Mucormycosis infection in Covid-19 patients. He said:

• Severe viral infections are one of the causes which suppress the immunity. In COVID-19, the count of various white cells that are responsible for infection control and immunity gets altered which in turn makes a person more vulnerable to any kind of viral and fungal infections.
• Serum creatinine levels, which is one of the important markers of pathology for COVID-19, is deemed to be another contributing factor. This is a form of iron which is otherwise stored in the cells and not allowed to flow freely in the blood stream. In COVID-19, the serum creatinine levels increase, which is the most favourable condition for a fungus to thrive. Hence the fungus mucor flourishes where there are high levels of serum creatinine present in the blood.
• The condition of COVID-19 is a prethrombotic state that has proven to make patients vulnerable to blockage in vessels which in turn can cause damage to the tissue causing the fungus to thrive (hence a D-dimer test is done to check any irregularities here). These factors are based on previously acquired knowledge, general physiology on how patients for mucormycosis were treated and diagnosed in the pre COVID times.

"As studies and researches evolve, we might be able to elaborate on more concrete information," Dr. Zaidi noted.

Dr. Zaidi concluded: It is essential that people stay aware and concerned about mucormycosis. But not every covid patient is vulnerable to mucormycosis. Those who have been on immunosuppressant drugs and long-term steroids to protect them from any fatality need to be more cautious. People who have uncontrolled or unchecked diabetes and getting COVID care at home have been at more risk, as consumption of steroids to control COVID complexities has caused a spike in diabetes levels.

This is only for your information, kindly take the advice of your doctor for medicines, exercises and so on.   

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1 in 3 Covid patients who recovered have neurological, mental health disorders

At least one-third of Covid-19 patients received a neurological or psychiatric diagnosis within six months of infection, a study of over 2,30,000 patients has said. Thirteen per cent of these had never received a neurological or psychiatric diagnosis before, it added. 

The study,  claims that the SARS-CoV-2 virus causes serious disorders that affect the nervous system, which leaves patients in poor health months after they have recovered from Covid-19.

Since the beginning of the pandemic, there have been reports that those diagnosed with Covid-19 are at increased risk of neurological disorders.

Researchers have also reported that Covid-19 patients are likely to develop mood and anxiety disorders in the first three months after infection.

However, the Lancet study is the first to analyse the health records of 2,36,379 patients from the US-based TriNetX network — a global health research network — for a period of six months.

The study included patients older than 10 years who were infected with the virus after 20 January 2020 and were still alive on 13 December 2020.

The data was compared with that of 1,05,579 patients diagnosed with influenza and 2,36,038 patients diagnosed with other respiratory tract infections.

Study conclusions

According to the study, 34 per cent of the Covid-19 patients examined had been diagnosed with a neurological or mental health disorder in the six months after infection. For 13 per cent of these, it was their first recorded neurological or psychiatric diagnosis.

Of the patients studied, 17 per cent were diagnosed with anxiety disorders, 14 per cent with mood disorders, 7 per cent with substance misuse disorders, and 5 per cent with insomnia.

The incidence of neurological outcomes was found to be lower — 0.6 per cent for brain haemorrhage, 2.1 per cent for ischemic stroke or brain stroke, and 0.7 per cent for dementia.

“These are real-world data from a large number of patients. They confirm the high rates of psychiatric diagnoses after Covid-19, and show that serious disorders affecting the nervous system (such as stroke and dementia) occur too,” Paul Harrison, lead author of the study, from the University of Oxford, said in a statement

“Although the individual risks for most disorders are small, the effect across the whole population may be substantial for health and social care systems due to the scale of the pandemic and that many of these conditions are chronic,” added Harrison.

‘Severe Covid increases neurological risk’

The study also identified distinctions within the severity of the infection.

For instance, it was found that those who had severe Covid-19 were at a higher risk of a neurological or psychiatric diagnosis — 38 per cent — as opposed to 34 per cent overall.

The risk further increased to 46 per cent for those who were admitted in intensive care, and 62 per cent for those who suffered delirium during the infection.

The team also looked at people who experienced flu and other respiratory tract infections over the same time frame to help understand whether these neurological and mental health complications were linked specifically to Covid.

They found that there was a 44 per cent greater risk of neurological and mental health diagnoses after Covid-19 than after the flu.

“Our results indicate that brain diseases and psychiatric disorders are more common after Covid-19 than after flu or other respiratory infections, even when patients are matched for other risk factors,” Max Taquet, a co-author of the study, from the University of Oxford, said.

“We now need to see what happens beyond six months. The study cannot reveal the mechanisms involved, but does point to the need for urgent research to identify these, with a view to preventing or treating them,” Taquet added.

This is only for your information, kindly take the advice of your doctor for medicines, exercises and so on.     

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What causes blood oxygenation to drop in many Covid patients?

The decreased arterial blood oxygen levels in many Covid-19 cases could be caused by infection in carotid bodies by SARS-CoV-2, the virus responsible for the pandemic, says a new study.

Carotid bodies, located on either side of the neck next to the carotid artery, detect the drop in blood oxygen and send signals to the brain to stimulate the respiratory centre.

The new research, detailed in the journal Function, relies on experiments that have revealed a high presence of the enzyme ECA2, the protein the coronavirus uses to infect human cells, in the carotid body.

One of the physiopathological characteristics of Covid-19 that has most baffled the scientific and medical community is what is known as "silent hypoxemia" or "happy hypoxia".

Patients suffering this phenomenon, the causes of which are still unknown, have severe pneumonia with reduced arterial blood oxygen levels -- known as hypoxemia.

Patients with "silent hypoxemia" often suffer a sudden imbalance, reaching a critical state that can be fatal.

In patients with Covid-19, the coronavirus circulates in the blood.

Therefore, in this study researchers from the University of Seville in Spain suggest that infection of the human carotid body by SARS-CoV-2 in the early stages of the disease could alter its ability to detect blood oxygen levels, resulting in an inability to "notice" the drop in oxygen in the arteries.

If this hypothesis, which is currently being tested in new experimental models, is confirmed, this would justify the use of activators of the carotid body independent of the oxygen sensing mechanism as respiratory stimulants in patients with Covid-19.

This is only for your information, kindly take the advice of your doctor for medicines, exercises and so on.     

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https://gseasyrecipes.blogspot.com. feel free to view for easy, simple and healthy recipes    
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