White fungus: Here’s what Odisha doctor says

By Dr Sunil Kumar Kota

As per few reports, cases of white fungus is on upswing. COVID-19 patients are more
prone to white fungus as it suppresses immunity and it affects the lungs giving rise to similar
symptoms. Candida and Aspergillus are the major responsible fungi. These are more common
than black fungus and can give rise to more severe illness as well. People having
immunocompromised state due to Diabetes, long duration of steroid use, antibiotic abuse,
AIDS, organ transplant, immunosuppressant therapy, cancer or cancer chemotherapy are
more prone to develop these infections.

Candidiasis:
Candida yeasts are generally present in healthy humans on the skin, body's normal
oral and intestinal flora; however, their growth is normally limited by the human immune
system and by the bacterial flora occupying the same locations in the human body.  These
infections are more common in children, elderly and women. Other risks include dentures,
breastfeeding, Hormone replacement therapy, oral contraceptive therapy and infertility
treatments. This fungus affects skin nails, mouth, throat (pharynx), esophagus, private parts/
genitals. The invasive form can infect  gastrointestinal tract, urinary tract, and respiratory
tract. Candida requires moisture for growth on the skin (prolonged swimwear, diaper usage).
External use of detergents or douches or internal disturbances (hormonal or physiological
during pregnancy) can perturb the normal vaginal flora and result in local candidiasis. Breast-
feeding mothers may also develop candidiasis on and around the nipple as a result of
moisture created by excessive milk-production. Vaginal candidiasis can cause congenital
candidiasis in  newborns . Use of inhaled corticosteroids increases risk of candidiasis of the
mouth. Individuals at risk for invasive candidiasis include low birth weight babies, people
recovering from surgery, people admitted to intensive care units, and those with an otherwise
compromised immune system.

The common symptoms include irritation, white patch or white discolorations in the
tongue, around the mouth, and throat. Symptoms of esophageal candidiasis include difficulty
swallowing, painful swallowing, abdominal pain, nausea, and vomiting. Skin can have
itching, irritation, and chafing or broken skin with nail involvement. Common symptoms of
gastrointestinal candidiasis in healthy individuals are anal itching, belching, bloating,
indigestion, nausea, diarrhea, gas, intestinal cramps, vomiting, and gastric ulcers. It can also
come up with symptoms of urinary and respiratory involvement.

Aspergillosis

The aspergillus mold is everywhere — indoors and outdoors. Most of the strains are
harmless, but a few can cause serious illnesses when people with weakened immune systems,
underlying lung disease (asthma, cystic fibrosis) or lung cavities (emphysema, tuberculosis,
sarcoidosis etc) inhale their fungal spores. The fungus is present on compost piles, stored
grain, unclean water, decaying vegetation & leaves. Unsanitary use of oxygen cylinders
(using tap water in the humidifier) can heighten the risk of contracting white fungus.

In some people, the spores trigger an allergic reaction (Allergic Bronhopulmonary
Aspergillosis). Other people develop mild to serious lung infections and ball
formation(Aspergilloma). The most serious form of aspergillosis i.e. invasive aspergillosis
occurs when the infection spreads to blood vessels and beyond involving heart, brain and
kidney. The symptoms include fever, cough, sometimes blood in cough, wheezing, shortness
of breath, worsening of asthma symptoms, fatigue, weight loss. Sometimes the fungus may
invade sinus giving rise to stuffy nose, head ache, facial and eye pain. Invasive forms can
present with chest or joint pain, headaches or eye symptom, skin lesion and systemic
infection of heart, brain and kidney with occasional severe bleeding into lungs, which can be
fatal.

 

Prevention:

Emphasis should be laid upon proper blood sugar control, avoidance of injudicious
use of steroids, antibiotics, moist environment, use of clean water during oxygen delivery.
People should stay away from places where you're likely to encounter mold, such as
construction sites, compost piles and buildings that store grain.

 

Diagnosis:
Diagnosis is by fungal (KOH) staining of sputum, fungal culture, skin and blood tests
to look for allergy and antibodies, imaging (chest X Ray, CT scan), biopsy of involved tissue.
Respiratory, gastrointestinal, and esophageal candidiasis require an endoscopy to diagnose.

 

Treatment:
Candidiasis: Antifungals like  clotrimazole, nystatin, fluconazole, voriconazole. Sometimes
the invasive forms require intravenous Amphotericin-B, Capsofungin for a prolonged time

Aspergillosis: Simple, single aspergillomas often don’t need treatment, and medications aren’t
usually effective in treating these fungal masses. Instead, aspergillomas that don’t cause
symptoms may simply be closely monitored by chest X-ray. If the condition progresses, then
antifungal medications may be recommended. The goal in treating allergic
bronchopulmonary aspergillosis is to prevent existing asthma or cystic fibrosis from
worsening. The best way to do this is with oral corticosteroids. Antifungal treatments drugs
are the standard treatment for invasive pulmonary aspergillosis. The most effective treatment
is a newer antifungal drug, voriconazole or Amphotericin B with simultaneous monitoring of
kidney and liver function. Sometimes surgery to remove the fungal mass is the first-choice
treatment. Embolization may be required to stops lung bleeding caused by an aspergilloma. A
radiologist injects a material through a catheter that has been guided into an artery feeding a
lung cavity where an aspergilloma is causing blood loss. The injected material hardens,
blocking the blood supply to the area and stopping the bleeding.

 

[The writer is a Berhampur-based medical practitioner with specialisation in medicine and endocrinology.]

DISCLAIMER: The views expressed in the article are solely those of the author and do not in any way represent the views of Sambad English.