Classified by some doctors as “a nightmare within the pandemic”, mucormycosis has been growing exponentially in India, having reached almost 9 patients with Covid-19 in the country. Popularly called “black fungus”, the disease kills more than 50% of those affected. Here in Brazil, 29 cases have already been reported in the first five months of 2021 alone. Ministry of Health to BBC News Brasil, there were 36 records.

According to the federal agency, "it is not possible to relate, so far, the cases of mucormycosis registered in Brazil with Covid-19 and the variants of the virus", although the situation coincides with the worsening of the pandemic in the country.

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In mucormycosis, the fungus usually enters the nose and then enters the blood vessels of the face, creating dark spots wherever it passes. That's where the “nickname” black fungus comes from. Image: Stockpexel – Shutterstock

Experts do not believe that the situation in India will be repeated in Brazil

Epidemiologists say there is no reason to be alarmed. According to them, it is unlikely that a scenario like India's will occur in Brazil or elsewhere in the world. “This local situation does not pose a threat to global public health,” guarantees infectologist Alessandro Comarú Pasqualotto, a professor at the Federal University of Health Sciences in Porto Alegre.

“Mucormycosis is not something that will spread around the world”, adds Flávio de Queiroz Telles Filho, a professor at the Federal University of Paraná.

Although it seems a novelty, these fungi have been known and studied since the end of the 19th century and are already circulating in a good part of the world, including here, according to the doctors.

Why is black fungus doing so much damage in India?

According to Pasqualotto, India has a series of characteristics that explain the increase in cases of mucormycosis in the country. "The disease-causing agents are in the air and take advantage of the high humidity and hot temperature of that location."

The fungi that cause this condition, known as Rhizopus, Rhizomucor and Mucor, can be seen in bread and fruit mold, for example. They are present in many countries, including Brazil. 

The explanation for why such common fungi, apparently with little offensive potential, cause so much damage to some people, while others are not even affected, lies in the health condition of each one.

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According to Telles Filho, there are three situations that facilitate the development of mucormycosis: diabetes uncontrolled, oncohematologic diseases (such as leukemia), which require bone marrow transplantation, or the use of high doses of corticosteroid drugs, which have an anti-inflammatory action.

"India is one of the countries with the most diabetics in the world and is currently experiencing an uncontrolled Covid-19 pandemic, with a high number of hospitalized patients who need to take corticosteroids," explained the doctor, who is the coordinator of the Society's Mycology Committee Brazilian Institute of Infectology.

Poor health conditions in hospitals and wards in some regions of India facilitate the risk of contamination by fungi. Image: Francis Mascarenhas/Reuters

Added to this are the poor sanitary conditions of hospitals and wards in some regions of the country, which facilitates the risk of contamination by fungi.

Thus, there is a situation that covers a large number of vulnerable patients, with the immune system weakened by Covid-19, often with comorbidities (such as diabetes) and who need drugs that further interfere with the functioning of the cells of defense – the case of corticoids. To make matters worse, they are kept in places without proper hygiene. 

How the fungal infection that causes mucormycosis happens

In hospitalized people, the fungus can usually be aspirated naturally by themselves or enter through tubes and catheters that are attached to the veins. Another form of access is the intestine: as fungi colonize much of the digestive system along with bacteria, they can take advantage of an imbalance in the microbiota (caused by the use of antibiotics, for example) to establish themselves there or even invade blood circulation.

In the case of mucormycosis, the fungus usually enters through the nose and soon enters the blood vessels of the face, creating dark spots wherever it goes. That's where the “nickname” black fungus comes from.

In a normal situation, the immune system itself may be able to deal with these fungal advances and prevent further aggravation. But at a time of weakness caused by the pandemic, this natural defense mechanism may not work so well, allowing these harmful beings to wreak havoc.

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