What is mucormycosis, or ‘black fungus’?
Mucormycosis – often called ‘black fungus’ or ‘black mould’ – is a rare and serious fungal infection that can infect your whole body, including your skin, lungs, heart, brain and blood.
It happens when a type of fungi – usually a fungus called Mucorales – gets into your body, for example, when you breathe the fungus in or eat it.
We come into contact with many fungal spores (a form of fungus that’s able to survive for a long time) every day because they live in our environment, including in the air and soil. They usually don’t cause any problems, but, if you have a weak immune system or an underlying medical condition, they can cause a disease like black fungus.
Mucormycosis has always existed as a disease, but it came into the media spotlight in 2021 when cases of it rose among hospitalised COVID-19 patients in India during the pandemic.
There are 6 different types of mucormycosis, and your symptoms will depend on where in your body the infection is.
This is the most common type and it happens when the fungus infects your face, eyes, sinuses (the spaces behind your cheekbones and forehead) and brain.
Symptoms you might have include:
- swelling or redness on one side of your face
- a headache
- a blocked nose or feeling of pressure in your face
- black marks or sores on your nose and inside your mouth
- black liquid coming out of your nose and mouth
- a fever
- blurred or double vision
- trouble moving your eyes
This happens when you breathe the fungus into your lungs. Your symptoms may get worse quickly and can include:
It might also spread to your heart or through your blood to other organs.
This type infects your skin. It can cause skin rashes and other symptoms, such as:
- wounds (ulcers)
- black marks on your skin
- skin pain
- skin redness
- your skin feeling hot and looking red
- swelling of your skin
Unlike the other types of mucormycosis, cutaneous mucormycosis doesn’t usually spread to other parts of the body.
When you eat fungal spores and they infect your gut, it’s known as gastrointestinal mucormycosis – but it’s a rare type.
Its symptoms may include:
- tummy pain
- feeling sick (nausea) or being sick (vomiting)
- vomiting blood
- blood in your poo
Renal mucormycosis doesn’t happen often either – it’s when the fungus infects your kidneys. You might have:
- back pain on one side or both sides
- a fever
Disseminated mucormycosis is when the fungus spreads through the blood to other parts of your body. It usually only happens if you’re really sick from another medical condition, such as diabetes or blood cancer, so it can be hard to know which symptoms are from the mucormycosis and which are from your underlying condition.
Disseminated mucormycosis can be life-threatening. If it’s in your brain, you might be very confused or fall into a coma, which is a state of unconsciousness where you can’t be woken.
When to see a doctor about mucormycosis
Mucormycosis is a rare disease and there are lots of conditions that are more common that can cause similar symptoms. Some of these are more serious than others, so see a doctor as soon as possible if you have any of the symptoms listed above.
Go to a hospital or emergency department immediately if you:
- have a sudden really bad headache
- have a bad headache and a fever, stiff neck, are vomiting or have a dislike of bright lights
- have trouble moving your arms or legs because they feel weak, or drooping on one side of your face
- feel confused
- feel drowsy
- vomit blood
- have a lot of blood in your poo
- have very dark or black poo
- have very bad tummy pain
- have a fever, blood in your pee and back pain on one side
- feel short of breath
- cough up blood
- have chest pain
- have swelling or redness around your eye that’s spreading
- suddenly have blurred or double vision
- you feel very unwell, have a fast heart rate, a fever or have other signs of sepsis
- have black fluid coming out of your nose or mouth
What causes mucormycosis?
There are some conditions that increase your risk of getting infected with the fungi that cause mucormycosis. It can happen when your immune system is very low and it’s more common if you are very old or very young. Conditions that put you at risk include:
- taking steroids
- blood cancer
- blood or organ transplant
- injecting drugs
- HIV and AIDS
- having too much iron in your body and being treated for too much iron
- kidney problems
- certain other medicines, like antibiotics and an antifungal medicine called voriconazole
It isn’t contagious, which means you can’t get it from another person or spread it to another person.
It doesn’t happen often, but the fungus may infect a wound if a contaminated dressing is used, or get into a traumatic wound from a military injury or a bomb blast. Outbreaks can also happen after natural disasters such as tornadoes or volcanic eruptions.
What is the link between COVID-19 and mucormycosis?
Cases of mucormycosis were first reported among COVID-19 patients admitted to hospital in India during the height of the pandemic in late 2020. Steroids are used as a treatment for serious COVID-19, so this medication may have caused these infections. Most of those infected with both COVID-19 and mucormycosis also had diabetes.
At the moment, the link between COVID-19 and mucormycosis isn’t fully understood.
How is mucormycosis diagnosed?
A doctor will talk to you about your symptoms and do a physical exam. If they think you have mucormycosis, they’ll usually perform some tests, such as:
- a biopsy
- taking a sample of your phlegm or fluid from your nose – they might look under a microscope to try find the fungus or try to grow it in a laboratory
- blood tests
- a urine test
- an X-ray, CT or MRI scan of your lungs, sinuses or other body parts, depending on where your infection is
- an endoscopy – if you have gastrointestinal mucormycosis
- a nasal endoscopy – a procedure that looks into the nose and sinuses
Treatment often works the best when it’s started as early as possible. It might include:
- surgery to cut away any dead tissue
- antifungal medication given either in the vein (IV) or by mouth, such as amphotericin B or posaconazole
- other medication, such as medicine to reduce iron in your body, or hyperbaric (high pressure) oxygen – these may be tried as treatment, but more research is needed to find out if they really work
If you have an underlying medical problem, your doctor will usually try to treat this. They might also stop or reduce any medication that might be making it worse.
Can you prevent mucormycosis?
Fungal spores are everywhere in our environment, so it’s difficult to avoid breathing them in or eating them, for example, including the ones that cause black fungus.
If you have a weak immune system, you can try some ways to lower your chances of getting it by protecting yourself from your environment, but they’re not guaranteed to stop you getting mucormycosis. They include:
- cleaning any skin wounds well with soap and water, especially if you’ve been exposed to soil or dust
- avoiding anything that may mean you come into contact with soil or dust, like gardening, or wearing gloves and covering other parts of your skin when you do come into contact with soil or dust
- staying away from lots of dust, for example, in construction sites. You could wear a face mask called a respirator to help you, if you can’t not be in dusty areas.
- not going near flood water or flooded buildings after natural disasters
If you’re at high risk of getting this disease – if you’ve had an organ transplant, for example – a doctor may give you antifungal medicine to prevent mucormycosis.
A vaccine to stop you getting mucormycosis hasn’t been developed yet.
What can you expect if you have mucormycosis?
Mucormycosis is a serious infection, which can be life-threatening in about 50% of people, especially when you have other conditions like diabetes. You’ll usually be looked after in hospital, often in an intensive care unit (ICU) by a specialist team. Your chances of recovery are higher if it’s diagnosed and treated early.
If you’ve recovered from rhino-orbito-cerebral mucormycosis, you may have some scarring on your face, which more surgery may help with.
Your health questions answered
Can you get mucormycosis without COVID-19?
Mucormycosis is often seen in people who have an underlying condition or who take certain medications. It’s been seen in COVID-19 patients in India recently, but it’s not certain if it’s because of their COVID-19 infection or for another reason, such as medication they’re being treated with, like steroids, or because they have another underlying condition. COVID-19 is not the only condition that can increase your chance of getting mucormycosis – there are many others, including diabetes, having an organ transplant and burns.
Who gets affected by black fungus?
The fungus that causes black fungus, which is medically known as mucormycosis, is found in the world around us, including in the air and the soil – and for most people, it isn’t harmful. But it can infect people who have a weak immune system, caused by medication they take or a medical condition they have. These conditions include HIV and AIDS and some types of cancers – or you may get it if you’re malnourished.
How does black fungus enter the body?
Black fungus can be breathed in, eaten, or it can enter your body through a wound in your skin. It can also sometimes enter your body if you inject drugs, or through contaminated medical supplies or instruments in a hospital.
- mucormycosis – often called ‘black fungus’ – is a rare, serious fungal infection that can infect your whole body
- there are 6 different types of mucormycosis, including rhino-orbito-cerebral mucormycosis and pulmonary mucormycosis
- cases of black fungus were first reported among COVID-19 patients admitted to hospital in India during the height of the pandemic in late 2020
- treatment for black fungus may include surgery, antifungal medication or other kinds of medicines
- mucormycosis isn’t contagious, which means you can’t get it from another person or spread it to anyone