Florence Cunzolo
06/16/2021 3:56 PM
Clarín.com
Good Life
Updated 06/17/2021 8:29 AM
The havoc that the coronavirus pandemic causes in India due to the explosion of cases (it is close to 30 million confirmed, but the real figure is much higher) and the spread of the delta variant (reported for the first time there), is added in recent weeks a new cause for alarm: the appearance of an outbreak with thousands of cases of mucormycosis (popularly known as "black fungus"), associated with pictures of Covid-19.
In Argentina, at least three have already been produced
, so mycology specialists call to be vigilant about fungal coinfection in severe cases of coronavirus.
The three cases that were known to date were analyzed at the Mycology Center of the Institute for Research in Microbiology and Medical Parasitology (IMPAM), which depends on the Faculty of Medicine of the University of Buenos Aires (UBA) and the Conicet.
This was confirmed to
Clarín
María Luján Cuestas, director of the Laboratory for Research and Development in Mycology (LIDeMi) of IMPAM.
The researcher pointed out that there may be more, because mucormycosis is not notifiable.
Colonies and microscopy image of the so-called “black fungus”.
Images presented with permission of the authors of the Atlas of Clinical Fungi 2020.
An opportunistic fungus
Mucormycosis is not new
.
The fungus that causes it belongs to the Mucorales family.
"It is not black, it is taxonomically hyaline. It is popularly called black because it causes necrosis in the tissue,"
Roxana Gabriela Vitale, CONICET researcher, head of the Mycology Sector of the Parasitology Unit of the Ramos Mejía Hospital
, told
Clarín
.
The fungus "penetrates the blood vessels and can cause tissue necrosis or death, affecting the
paranasal sinuses, the orbital region and even the brain,
" said the researcher, who is one of the authors of the latest version of the Clinical Mycology Atlas which describes more than 700 species of fungi that cause fungal diseases.
"These fungi have always been everywhere, they did not appear now,
we live with them
. They are present in the environment, in the soil, in plants or decomposing food," says Vitale.
The novelty, he explains, is that the pandemic created a
favorable scenario
for them to develop in patients with severe covid.
They are known as
"opportunistic fungi"
because they cause disease in people with weakened defenses.
They have low incidence, but high mortality.
"Mucormycosis has always existed in Argentina," Cuestas agreed, "what happens is that now
we are seeing the first cases associated with covid
. And it does not necessarily occur in decompensated diabetic patients, which is in whom these conditions were mostly documented. It can occur in patients who did not have comorbidities and who, due to covid, ended up hospitalized in serious condition, in intensive care. "
Cuesta maintains that the warning is not intended to generate an alarm.
"The important thing is that health professionals know that this circulates, because mycoses are not easily diagnosed and
are not always in clinical suspicion,
" said the researcher, who is a professor in the Department of Microbiology, Parasitology and Immunology of the Faculty of Medicine.
"Not all people with diabetes will present mucormycosis, nor all those who had covid," Vitale reassured.
The factors that predispose to fungal coinfection are mainly
prolonged stays in intensive care
and treatment with corticosteroids, the Conicet researchers highlighted.
In a CyTA-Leloir Agency article, Vitale also listed other factors, including:
administration of broad-spectrum antibiotics
, damaged respiratory epithelium, mucociliary dysfunction, alveolar damage, immune dysregulation, local immune paralysis, and comorbidities (such as decompensated diabetes, among others).
"This scenario favors the development of the fungus, which
does not develop on the first day of
hospitalization, but later, due to all those factors that help. A healthy patient who has covid at home is going to be rare to get a mucormycosis", Vitale pointed out.
Roxana Vitale is a biochemist, doctor of medicine, researcher at CONICET and head of the Mycology Sector of the Parasitology Unit of the Ramos Mejía Hospital.
Clinical suspicion
The association usually occurs in "patients who are too serious due to covid and have
many systemic affectations
and that makes it difficult to suspect a fungal etiology," says Cuestas.
Mucormycosis can present as a
co-infection
in covid pictures, that is, when they occur at the same time;
but also as a
post-covid sequel
.
"Some cases have been reported after a while, because having received so many doses of corticosteroids leaves the stage for the fungus to take advantage of and cause the infection," says Vitale.
For this reason, it advises that people who have suffered severe covid pictures
attend medical check-
ups
after discharge
.
And that those who present diabetes as a comorbidity, have their picture well controlled ("it is important that they do not decompensate, since cases generally occur in uncontrolled diabetic patients, who have ketoacidosis").
What
symptoms
can warn of a mucormycosis?
"It can present with rhinorrhea, sinus pain, the periorbital area can swell, headaches. If you had covid, received high doses of dexamethasone, you have to control before the appearance of these symptoms. It may not be anything significant, but if it does You have to tackle it fast, "Vitale warned.
The researchers remarked that beyond the attention generated by the 'black fungus', there are more infections caused by other fungi that appear in these patients and that also cause a high mortality rate, such as covid-associated pulmonary aspergillosis (CAPA) and invasive candidiasis associated with covid (CAC), among others.
María Luján Cuestas (center) with members of the Mycology Research and Development Laboratory (LIDeMi) team.
An article published in the
Journal of Fungi
warned that the pandemic is creating ideal conditions for the appearance of
Candida auris
, a microorganism that some call "superfungi" due to the speed with which it has developed resistance to drugs.
The first two cases were confirmed in December 2020 in a hospital in Salvador de Bahía and since then another nine patients were diagnosed in the same hospital, some colonized (with the fungus in their body but without causing damage) and others infected.
"
Candida auris
is pan-resistant, resistant to many antifungals. But it was not made more resistant by COVID. There are more cases because COVID causes patients to spend a long time in intensive care,
with catheters, intubated, with corticosteroids, with antibiotics
of broad spectrum. This whole scenario predisposes to fungal infection, "analyzed Vitale, who has a doctorate at the Radboud University Medical Center in Nimegen and at the Westerdijk Institute for Fungal Biodiversity in Utrecht, the Netherlands.
In Argentina, no cases of
Candida auris
associated with covid
have been reported so far
, confirmed Cuestas.
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