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Published on: May 22, 2021
3 minute read
By: Dr Rajan Choudhary

COVID Associated Black Fungus: Succumbing To Black Fungus !

COVID associated Black Fungus: What you need to know

As COVID spreads across India, there has been an increase in reports of associated infection with a black fungus occurring in some patients. It affects the nose, mouth, eyes, and lungs, and can be fatal. This is an infection we need to be educated on, and early recognition of it can be life-saving. Today we will talk about Mucormycosis, the black fungus responsible for these infections, and what you should do to prevent or recognize an infection.

If you want to learn how to recognize the infection, go down to the INFECTION section of the article.

FUNGUS

When our body gets infected by a bacteria or virus, the signs and symptoms are often recognized early because bacteria and viruses are aggressive, with toxins and mechanisms designed to cause harm to our body and cause easily recognizable symptoms. Fungi on the other hand are slow-growing, and usually, our bodies can fight usually fight these infections before they become a problem. We breathe in fungal spores all the time, especially when outside, in the garden, or in fields, and they cause no harm.

Mucormycosis, the responsible fungus, is found in soil, and decaying fruits and vegetables. It can enter our body by inhalation, by eating foods infected with it, or by direct contact with an open wound, thereby entering our blood. It can be found inside the nose of healthy people, causing no problems or disease. Before the COVID pandemic, infection by mucormycosis was up to 80 times more prevalent in India than in other developed countries, though still rare.

IMMUNOSUPPRESSION

Looking at case reports of patients infected with mucormycosis shows a common theme. Immunocompromised patients are at much higher risk of infection by the fungus and are more likely to have severe disease. This includes patients with diabetes, poorly controlled diabetes, patients taking steroids, organ transplant patients (who are usually on immunosuppressive medications to prevent rejection), those with blood cancer (leukemia/lymphoma, reducing your blood immunity).

Diabetes (especially poorly controlled diabetes) is a major problem in these cases, as diabetes is fairly common in India, can lay unrecognized, and if not controlled or treated appropriately the rising blood sugar levels can damage your arteries, nerves, and significantly lower your immunity. Any infection in diabetic patients can be more difficult to treat and spread more quickly, and this is made worse by COVID-19.

COVID causes widespread inflammation throughout the body, especially the lungs, and the resulting damage causes difficulty breathing and death by respiratory failure. Steroids are currently our best way to treat COVID, by suppressing the body’s immune system and preventing lung damage. Unfortunately, this also allows mucormycosis spores inhaled by COVID patients to infect the now vulnerable, damaged airway, lungs, and sinuses, and start spreading. The body’s response to the infection is dampened by the steroids, and in those with diabetes, it is hindered further.

INFECTION

The black fungus usually spreads in the nose and sinuses of the skull, as it prefers a warm, humid environment. From here it can spread into the eyes and in rare cases the brain.

Recognize the symptoms of the fungus, and be very suspicious in patients with diabetes or those who have had high doses of steroids.

- Facial swelling on one side

- Nose or sinus congestion

- Pain in the sinuses, around the nose, and eyes

- Black mold growing around the nose or mouth

- Fever, headache

When it infects the lungs it can cause symptoms such as cough, shortness of breath, or chest pain. Unfortunately, this can be difficult to separate from symptoms of COVID infection.

If you suspect you or someone you know has these symptoms, and they have the risk factors of immunosuppression or diabetes, you should visit a doctor early. Mucormycosis has a high mortality rate, and a delay in diagnosis by even a week can double it. Your doctor will take swab samples from your nose and look for signs of the fungus under a microscope. Blood tests and scans are also helpful in identifying the fungal infection.

TREATMENT AND PREVENTION

Treatment of mucormycosis requires IV antifungals such as Amphotericin B and may involve surgery to remove the infected areas and prevent further spread. This can include surgery in and around the nose, sinuses, and in rare cases even the eyes. This all depends on the extent of the fungal infection.

Prevention is key in these cases. Simple measures such as wearing a mask to reduce inhalation of spores can minimize infection, especially in the vulnerable, though it may not prevent it if they already had spores present in their nose and sinuses. Glucose tests to look for diabetes, and strict control of diabetes will improve your chances significantly. Keeping your blood sugar levels within the normal range is very important, so if you are diabetic now is the time to stick to your diabetic diet and medications.

Finally, we need to be careful when using immunosuppressive medications to treat COVID, and determining which patients should receive steroids (dexamethasone, prednisolone) and other drugs such as tocilizumab. If you are young and healthy, or you have a milder infection of COVID-19, it may be better for you to not take steroids early. Those with more serious COVID-19 infections may need steroids to survive, and in these cases frequent checks for mucormycosis infection is advisable.

The rise in this rare fungal disease in patients with COVID-19 presents a problem, as we do not have much literature to base our recommendations on, the disease is slow-growing and can be difficult to treat. But as always, understanding the disease process for black fungus and knowing its symptoms is important, as is informing your family and friends about this disease.

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Asthma Symptoms in Adults: Early Signs, Triggers, and When to Seek Care

Asthma is often perceived as a childhood condition, but a significant number of cases develop or persist into adulthood. In India, adult asthma is increasingly recognised due to rising air pollution, occupational exposure and lifestyle-related risk factors. Unfortunately, asthma symptoms in adults are frequently misdiagnosed as recurrent infections, allergies or age-related breathlessness, leading to delayed treatment.

Understanding adult asthma symptoms is critical for early diagnosis, effective control and prevention of severe attacks.

What Is Asthma?

Asthma is a chronic inflammatory disease of the airways. In asthma, the airways become:

inflamed
narrow
overly sensitive to triggers

This leads to difficulty in breathing, especially during exposure to specific stimuli.

Why Adult Asthma Is Often Missed

Adult asthma symptoms may:

appear gradually
vary in severity
mimic common respiratory conditions

According to Indian Council of Medical Research and WHO data, many adults remain undiagnosed for years, increasing the risk of complications.

Common Asthma Symptoms in Adults

Wheezing

A high-pitched whistling sound while breathing, especially during exhalation, is a classic asthma sign.

Shortness of Breath

Adults with asthma often feel:

breathless during routine activities
difficulty taking deep breaths

This may worsen at night or early morning.

Chest Tightness

Many describe a sensation of pressure or tightness in the chest, which can be mistaken for heart-related issues.

Chronic Cough

A persistent cough, especially:

at night
early morning
after exercise

is a common but overlooked asthma symptom.

Symptoms That Worsen With Triggers

Asthma symptoms often intensify after exposure to specific triggers.

Air Pollution and Smoke

Urban pollution, vehicle emissions and indoor smoke significantly worsen asthma symptoms in adults.

Allergens

Dust mites, pollen, mould and pet dander are common triggers.

Respiratory Infections

Viral infections can trigger asthma flare-ups or reveal undiagnosed asthma.

Physical Activity

Exercise-induced asthma causes breathlessness and wheezing during or after physical exertion.

Weather Changes

Cold air, humidity and sudden temperature changes can aggravate symptoms.

Adult-Onset Asthma

Adult-onset asthma differs from childhood asthma.

Characteristics include:

onset after age 20–30
less association with childhood allergies
more persistent symptoms
higher likelihood of severe disease

Occupational exposure and hormonal changes contribute to adult-onset asthma.

Risk Factors for Asthma in Adults

Several factors increase asthma risk:

long-term exposure to pollution
smoking or passive smoking
occupational chemicals or dust
obesity
family history of asthma
chronic sinusitis or allergies

Women may experience asthma onset or worsening during hormonal changes.

When Asthma Symptoms Become Serious

Seek immediate medical attention if experiencing:

severe breathlessness
difficulty speaking in full sentences
bluish lips or fingertips
rapid worsening of symptoms
poor response to usual inhalers

These signs indicate a potentially life-threatening asthma attack.

How Adult Asthma Is Diagnosed

Diagnosis includes:

detailed symptom history
physical examination
lung function tests (spirometry)
response to bronchodilators

Early diagnosis improves long-term outcomes.

Impact of Untreated Asthma

Untreated asthma can lead to:

frequent attacks
reduced lung function
sleep disturbances
missed workdays
reduced quality of life

According to Lancet respiratory studies, uncontrolled asthma increases hospitalisation risk.

Managing Asthma Symptoms in Adults

Effective asthma management focuses on:

identifying and avoiding triggers
using prescribed inhalers correctly
monitoring symptoms regularly
maintaining follow-up care

Asthma action plans help patients recognise worsening symptoms early.

Role of Preventive Healthcare

Preventive healthcare helps:

detect asthma early
assess lung function
guide lifestyle modifications

Regular health checkups are especially important for individuals with respiratory symptoms or occupational exposure.

Lifestyle Measures That Support Asthma Control

Helpful practices include:

avoiding smoking
improving indoor air quality
wearing masks in polluted environments
maintaining healthy weight
regular, moderate exercise

Lifestyle support complements medical treatment.

Mental Health and Asthma

Stress and anxiety can worsen asthma symptoms.

Stress management:

reduces symptom frequency
improves medication response

Holistic care improves asthma outcomes.

Importance of Medication Adherence

Asthma medications work best when:

taken regularly as prescribed
inhaler technique is correct

Skipping treatment increases flare-up risk.

Long-Term Outlook for Adults With Asthma

With proper management:

symptoms are well controlled
severe attacks are preventable
normal activity levels are achievable

Most adults with asthma lead active, productive lives.

Conclusion

Asthma symptoms in adults are often subtle, variable and easily mistaken for common respiratory problems. Wheezing, breathlessness, chest tightness and chronic cough should not be ignored, especially when triggered by pollution, exercise or weather changes. Early diagnosis, trigger control and consistent treatment are essential to prevent severe attacks and preserve lung health. Recognising adult asthma early empowers individuals to manage symptoms effectively and maintain a good quality of life.

References

Indian Council of Medical Research (ICMR) – Respiratory Disease and Asthma Studies
World Health Organization (WHO) – Asthma Management and Prevention Guidelines
National Family Health Survey (NFHS-5) – Respiratory Health Indicators
Lancet Respiratory Medicine – Adult Asthma Outcomes and Management
NITI Aayog – Air Pollution and Respiratory Health Reports
Statista – Global Asthma Prevalence and Trends

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