Rhinocerebral Mucormycosis, also known as black fungus, is a dreadful fungal infection caused by fungi within the Mucorales group. The fungal infection is caused by a group of molds called micromycetes. These molds live throughout the environment. Rhinocerebral Mucormycosis mainly affects people who have health problems like diabetes, cancer, post covid or take medicines that lower the body’s ability i.e, immunosuppressant to fight germs and sickness. The disease is usually characterized by hyphae growing in and around blood vessels, nerves and might be potentially life-threatening in diabetic or severely immunocompromised individuals.
Initially, this fungus can infect the paranasal sinuses, causing pain, redness, swelling around the cheek, forehead, or sometimes black tar-like foul-smelling nasal discharge. If untreated this infection crawls up to the brain.
Patients have neurological manifestations, which include headache, dizziness, decreased alertness, difficulty in concentration, disorders of smell and taste, seizures, strokes, weakness, and muscle pain. Patients have several key signs which point towards Rhinocerebral rhinocerebral mucormycosis. One such sign is a fungal invasion into the blood vessels which results in the formation of blood clots and surrounding tissue death due to a loss of blood supply. one-sided headache behind the eyes, facial pain, fevers, nasal congestion that progresses to black discharge, and acute sinusitis along with eye swelling.
The disease may affect the entire nervous system, including the brain, spinal cord, and nerves as well as the muscles. There are many different ways Rhinocerebral mucormycosis can cause neurological dysfunction, Because this disease may affect multiple organs (lung, kidney, heart), the brain may also suffer from lack of oxygenation or from clotting disorders that may lead to ischemic or hemorrhagic strokes. This fungus may cause direct infection of the brain and meninges. Finally, the reaction of the immune system to the infection may cause inflammation that can damage the brain and nerves.
Diagnosis is mainly based on a clinical evaluation by a neurologist or ENT surgeon. Imaging with contrast MRI (or contrast CT if MRI is not feasible) is essential to understand the extent of involvement and should be done as soon as possible. The treatment of infection itself requires a combination of medicines and surgery. Some antifungal drugs are effective in killing the fungus and have to be started as soon as possible. These are given as injections under hospital admission. Unfortunately, the medicines themselves are unable to fully control the infection and have to be combined with surgical removal of infected tissue.