A take on Mucormycosis

Dear readers,

Recently too much is being discussed about post-covid

complications, especially Mucormycosis. Mycosis is the medical term

used for fungal infections. The black fungus, which is known as

mucor, is the causative pathogen for this infection.

Let us understand some basic facts about fungal infections.

 Fungus is part of nature. It is always there around us, mainly in the

decaying food and soil and animal excreta.

 Mucormycosis is caused by Rhizopus or Absidia or Mucor fungi

which belongs to Mucoraceae family. Studies show that Rhizopus

is responsible for 90% of rhino-oculo-cerebral infection (affecting

nose, eye and brain).

 Its spores always wait for right atmosphere to grow and multiply,

be it food item, a plant or a human body. So it is always called as

opportunistic infection.

 This infection is usually unilateral (one sided) and rarely bilateral.

 Our immune system is capable of fighting with this fungus and

maintain our health. So, inspite of its presence around us we

usually do not get infected.

 Who are at risk?

1. Patients with uncontrolled Diabetes mellitus.

2. Immunocompromised patients like malignancies(cancer),

chemotherapy, organ transplantations.

3. improper intake of antibiotics and corticosteroids (prolonged

intake or excessively high dose).

4. Active or recovered covid -19 patients.

These conditions kill good bacteria in gut and reduce immunity

that gives opportunity to this fungus to enter the body and grow.

 This fungus grows rapidly where there is warmth, moisture and

acidic to neutral or slightly basic medium like blood. Also,

presence of starch, carbohydrates and sugar accelerates the

fungal growth. Easily noticeable example is black fungus growth

on leftover bread.

 The spores enter human body through inhalation or ingestion.

 Pathogenesis-

Spores enter the nasal cavity through inhalation—start growing

on nasal mucosa—high iron, high glucose level and nutrition-rich

medium of blood enhance rapid growth—infection extends

directly to paranasal sinuses—from there it extends to orbit and in

later stages to brain— as it grows, it invades deeper tissues and

leads to tissue necrosis (death of tissue). This dead tissue leads to

further complications.

Necrosis of tissue helps fungus to invade in deeper tissues like

that of wall of blood vessels and leads to ischemia and

thrombosis.

 Mucormycosis can affect different areas and accordingly classified

in different types like- rhino-oculo-cerebral (brain, eye and

sinuses), pulmonary(lungs), cutaneous(skin), gastrointestinal,

disseminated (blood stream).

 Common symptoms-

Rhino-oculo-cerebral mucormycosis, which is common nowadays (as

a post covid complication), are-

Headache, redness in the eye(s) and around nose, swollen eye, pain

in eye and surrounding area, blurred vision, unilateral blackish nasal

discharge, unilateral nasal congestion, fever etc.

Pulmonary mucormycosis symptoms- breathlessness and cough,

fever etc.

 Treatment-

1. Early diagnosis

2. Aggressive debridement

3. Systemic antifungal therapy (Amphotericin B, Posaconazole)

4. Controlling underlying comorbid factors like uncontrolled

diabetes.

5. Surgery

This is brief idea as per conventional medicine.

Ayurveda and Mucormycosis

As existence of fungus is as old as human beings, ayurvedic legends

like Charak and Sushrut must have had knowledge of it. They have

not mentioned about fungus with specific name. When we study

aagantuj vyadhi or sannipata jwara (vyadhi) or dhatugata kushtha,

raktaj krimi we can corelate them with fungal infection.

fungal infection is caused by external factor, fungus. So, it can be

considered as an aagantuj vyadhi (exogenous disease).

Charakacharya says that name of the disease is not important but

understanding pathology (samprapti) is important to treat a disease.

Here charakacharya explains that diagnosing the disease by name is

not possible many times. In such cases also, by understanding which

doshas are vitiated, depth of involvement of doshas with dooshyas

and basic prakruti of patient, a vaidya can successfully treat a

disease.

According to Ayurveda, dosha (basic principles) and dooshya (sapta

dhatu: seven types of tissues) are involved in the pathogenesis of a

disease. Even aagantuj vyadhi turns into Nij vyadhi (endogenous

disease) at one point of time.

 Jwara is the term used as synonym to vyadhi i.e. disease. So

when we read about sannipata (where all 3 doshas are

involved) jwara in jwara chikitsa adhyaya in Charak Samhita,

we can apply these treatment principles to other sannipatik

vyadhis also (like kushtha, rajyakshma, kshayaj kasa, dushta

pratishyaya).

 In nasaroga (nasal diseases) it is mentioned that neglected

nasarogas produce diseases of ears & eyes (ref. Ma.

Nidan/nasaroga/27)

 Yogratnakar mentions about asthimajjagat pratishyaya

resembling with paranasal sinus infection and symptoms like

tenderness, severe pain.

 The interaction of altered functions of different qualities of

doshas is known as pathogenesis of disease. It produces

different symptoms.

 These symptoms differ as per which gunas/qualities of dosha

are altered – accumulation (Chay), aggreevation (prakop) and

spread (prasar).

 Vitiated doshas combine with different dhatus, affect them

along with strotasas and produce the disease.

 When all three doshas get involved, complexity and severity of

the disease increases and treatment becomes tough and

prognosis becomes bad.

 Following chart explains briefly about involved dosha-dooshya

and strotasas in fungal infection.

When these vitiated 3 doshas spread all over body and affect

dooshyas (dhatus) mentioned above in the chart, the strotas

carrying that particular dhatu also get affected. According to

affected strotas, symptoms are produced.

Symptoms:

We have seen earlier that it is a rapidly growing, painful and fatal

disease, causing disfigurement with high mortality rate. We get

some references in kushtha vyadhi resembling this.

अतिश्लक्ष्णखरस्पर्शस्वेदास्वेदविवर्णता:|

दाह: कंडूस्त्वाचि स्वापतोद: कोठोन्नति: श्रम:||

व्रणानां अधिकम् शूलम् शीघ्रोत्पत्ति: चिरस्थिति:|

रूढानापि रुक्षत्वम्……………कुष्ठलक्षणमग्रजम्|| Ashtang hridaya/nidan.-14/11-13

Asthimajjagat kustha (disease affecting bones and

nerves):

नासाभंगो अक्षिराग: च क्षतेषु कृमिसंभव:|

स्वरोपघातश्च भवेत् अस्थिमज्जासमाश्रिते|| Madhav nidan kustha/29

Madhav nidan mentions about raktaj krumi , which are invisible and stay in

blood whereas Charak believes reasons for kushta are the same as

that of raktaj krumi. Both the authors mention that one of the causes

of these diseases is soiled food, leftover food.

As mentioned earlier, as per dosha, dooshya & strotas involvement,

symptoms differ.

Ex: rasavaha/raktavaha/mamsavaha strotas – skin discolouration,

burning sensation, swelling, pain, itching, dryness, pus formation,

necrosis, headache etc

Pranvaha strotas – shortness of breath, cough, hiccough, fever etc.

Symptoms as per dosha predominance in mucormycosis

Vata- headache, pain in and around eye, nasal congestion,

shortness of breath

Pitta- fever, redness, necrosis, blackish red nasal discharge

Kapha- swelling, heaviness etc

Treatment:

While treating mucor infections, we think of sannipata.

Line of treatment of sannipatik vyadhi depends on-

a) Chief complaints (Pradhan lakshanas)

b) Involvement of tissues (dhatus)

c) Extent of involvement of vitiated doshas

d) Damage to organs (avayava vikruti)

e) Strength of patient (rugna bala)- physical and mental.

f) Krumi (exogenous factor like microbe, virus or fungus)

 As we always emphasize on nidan parivarjan (avoiding

causative factor) in Ayurveda, first and foremost treatment

is Dhoopana (fumigation).

Dhoopana is done for purification of air with the help of

certain krumighna dravyas like Nimba, Vidang, Kustha, Guggul,

Vacha, Haridra.

 We have to check the status of agni in the patient and

accordingly deepana/pachana dravyas(appetizing and

digestive potency ) like chitrak, jeerak, aamalaki, shunthi,

pippali, nagveli etc. can be given.

 Liver is the main organ related to immunity. So, drugs giving

strength to liver like katuki, nimba, triphala can be used.

 Nimba, guduchi, sariva, kushtha, haridra, triphala and musta

are few drugs that can be used by different methods.

 Charak has mentioned panchkashayas (five types of

decoctions) in jwara adhyay based on involvement of

dhatus. Here also, after analyzing properly we can use these

kashayas as per dhatus involved.

 Panchakarma procedures are chosen by studying patient’s

strength, spread of disease, involvement of organs and other comorbidities.

Local eye wash (if eye is involved) with Kashaya rasa dravyas like

panchavalkal, alum. Shirovirechan with anu taila (nasal

drops) and raktmokshan with jalouka (leech therapy) are

also advisable in certain cases.

 Control other comorbidities, if any.

 Counseling to patient.

In extreme damage to tissues, Charak also recommends surgery.

मांसजानां तु संशुद्धि: शस्त्र क्षार अग्निकर्म च | Cha. su.28/23

Certain bhasmas like praval, suvarna, roupya may play important role in some cases.

One can not decide certain protocol while treating this infection with ayurveda. individual analysis plays vital role.

Diet is very important while treating a post covid patient of mucormycosis. The patient should be given nutritious, light and easy to digest food.

All the medication mentioned above has to be taken under

guidance of an ayurvedic consultant. Do not try any of them

on your own.

Hope this blog has given you brief insight of Mucormycosis.