CHEARS

Emergence of fungal infection post COVID-19 has raised rampant fear on second wave. Yellow fungus or mucor septicus is a rare fungal infection usually not infested in human, but in reptiles. The cause of this new infection is thought to be due to depressed natural immunity by COVID-19 infection. A 45 year old male patient was admitted to hospital with complaints of swelling on face due to which the patient was unable to open eyes and bleeding from nose and hematuria, at Ghaziabad, UP. The patient was on covid treatment for the past two months and recovering from it and presently affected by white fungus and black fungus. Sinus was normal in CT scan but after performing endoscopy physician concluded that the patient contracted with three types of fungi.

Yellow fungus is not contagious like black fungus and white fungus but more deadly and fatal than white fungus and black fungus. The mode of spread of infection is what makes it different from white and black fungus. Black fungus manifested with facial disfiguration, blackish discharge while yellow fungus attacks internal organ hence more severe and dangerous. The development and spread of infection depends on the physical health and chance for encountering with an infection by individuals. It is developed from mould spores from environment. It is assumed to be caused due to poor hygiene, unhygienic, stale food, inhalation of mould spores, increased humidity in room, inadequate ventilation of room, excessive or improper use of antifungals, or steroids. Irrational use of steroids is a major contributor for the infection. Mild to moderate dose of steroids for a maximum of 5 to 10 days should be used in management of COVID-19. Excessive dose can cause hyperglycemia, which provides an ambient atmosphere for fungus to nourish. Use of tap water instead of sterile water in humidifier of oxygen concentrators can be the cause of infection in patients under ICU admission.

Observing for symptoms at the earlier stage is difficult but crucial in the cure of infection. Infection may not start from lungs but attack internally reaching internal organs rendering patient feel out of energy and exhaustive, fatigue, loss of appetite, rapid weight loss, disrupted digestion, slow metabolism, sunken eyes, delayed wound healing, prolonged recovery timeline and devastating symptoms like internal bleeding and multiple organ failure and in severe cases to necrosis. Risk for the infection is more for immunocompromised patients like HIV AIDS, cancer, diabetes, dyslipidemia and patients admitted prior to intensive care units on ventilation with oxygen support.

The patient encountered with infection should start treatment earlier as it affects the patient internally. It is curable when detected earlier. Amphotericin B injection is the treatment option for this opportunistic infection. Preventive measure is the key for better control of infection. Safe hygienic practice and intermittent sanitisation, maintaining a humidity level between 30 to 40 %, avoiding unhygienic, old food products, wearing protective clothing and shoes, cleaning the surroundings by removing decayed substances and faecal matter can prevent from acquiring infection.