Key TakeawaysMucormycosis, or “black fungus,” is a rare fungal infection that produces life-threatening health complications with a high risk of death.Rising cases of black fungus in India have been linked to widespread steroid use, underlying health conditions, and immunosuppression from COVID-19. People with diabetes, in particular, are at an increased risk of developing the infection.Treating black fungus requires antifungal medications and surgical removal of infected tissue if it has spread to the brain. Even after people have recovered, there is a chance of long-term neurological complications.

Key Takeaways

Mucormycosis, or “black fungus,” is a rare fungal infection that produces life-threatening health complications with a high risk of death.Rising cases of black fungus in India have been linked to widespread steroid use, underlying health conditions, and immunosuppression from COVID-19. People with diabetes, in particular, are at an increased risk of developing the infection.Treating black fungus requires antifungal medications and surgical removal of infected tissue if it has spread to the brain. Even after people have recovered, there is a chance of long-term neurological complications.

As India faces a rising death toll from a second COVID wave, the country is also experiencing an increase in a fungal infection called mucormycosis, or “black fungus.” According to theBBC, India has reported over 8,800 black fungus cases, and the Indian government recently declaredblack fungus an epidemic.

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What Is Black Fungus?

Black fungus is a rare but serious infection. An immunocompromised state and overuse of steroid medications—two factors associated with COVID-19 infections—make the infection more likely. If not treated quickly, a black fungus infection can lead to life-threatening complications and carries a high risk of death.

You have a high chance of coming into contact with the fungus, but your chances of developing an infection are low if you have a strong immune system.

The Centers for Disease Control and Prevention (CDC) says the United States has about 1.7 black fungus cases per million; however, the number can vary because there is no national surveillance for tracking fungal infections.

Common symptoms for black fungus include:

Common Symptoms of Fungal Infections

People with facial mucormycosis typically develop swelling around the face or lip area, which can look like:

People with symptoms of an infection with black fungus will need to see their healthcare provider as soon as possible. They usually need to have a biopsy or CT scan to determine if a black fungal infection is present.

Who Is Most At Risk for Black Fungus Infection?

Nitin Desai, MD, CEO and CMO ofCOVID PreCheck,says the risk for black fungus infection is higher in people who are immunocompromised or who haveopen wounds.

Desai tells Verywell about an outbreak of mucormycosis during the 2011 tornado in Joplin, Missouri. “After the tornado, dirt and soil were all turned upside down, and people had cuts and bruises on them," recalls Desai. “People were found with mucormycosis after the tornado because people had lacerations and wounds here and there.”

Who Is At Risk for Black Fungus?

Organ Transplant Recipients

Desai says that one reason people whohave had an organ transplantare at risk for black fungus is that they usually need to be on steroid medication for life, putting them in a constant state of suppressed immunity.

“People with stem cell transplant, kidney transplant, or liver transplant are on immunocompromised medication to prevent the rejection of the organ,” says Desai. “So, they’re prone [to infection]”

The CDC reported that mucormycosis was the third most frequent fungal infection in people with stem cell transplants and made up 2% of invasive fungal diseases observed in people with solid organ transplants.

People Using IV Drugs

Drug use is also linked to black fungus infection. “IV drug users are prone to mucormycosis parties because they can be immunocompromised and are injecting dirty needles that then inject the fungus into them," says Desai.

People Who Are Malnourished

Malnourishment can affect how well the immune system responds to infections In fact, Desai says that malnourishment is a growing problem in poorer sectors of India and could be one of the many contributing factors to rising black fungus infections.

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Is Black Fungus Deadly?

The CDC reports a 54% mortality rate for black fungus infection, though the number fluctuates based on the site of infection, any underlying health conditions a person has, and the type of fungus.

“A typical mortality rate with rhino orbital cerebral mucormycosis is anywhere from 25% to 60%," says Desai. “If you have pulmonary mucormycosis, which I do not see a lot of reports in India, but if you have COPD,chronic asthma, or another lung condition, then you can develop the same fungus mucormycosis pulmonary variant with a mortality rate as high as 87%.”

Complications and Treatment

The good news is black fungus infection is treatable—but only if it’s diagnosed in time. Desai says that a lot of patients have infections in their sinuses or around their nose, but that “the problem happens when the blood drains from those areas, they go into the brain because they’re just right there.”

If mucormycosis invades the frontal lobe of the brain, it can causesymptoms of psychosisand disorganized speech. The infection also destroys tissue, erodes bone, and produces inflammation.

Debridment and Antibiotics

Desai says that one of his colleagues who is an ear, nose, and throat (ENT) surgeon in India is performing endoscopic procedures to treat infections that have spread to the brain.

“They are putting an endoscope in the nose to enter the sinuses, which sit in the cavities in the skull bone," says Desai. “They basically dig out and take all the necrotic bone tissue, clean out the brain, and then flush it with antifungals.”

What Is Wound Debridement?

After debridement, patients usually receive intravenous amphotericin B, which comes with serious side effects that last for weeks.

“This is a bad situation if you have either pulmonary or rhino orbital cerebral mucormycosis,” says Desai. Not only is the treatment drastic, but it also carries a high mortality risk. Even if a person survives the initial treatment, Desai says that “there’s a lot of operative intervention with repeat debridement to remove necrotic tissue,” and a person “may end up on an IV antifungal medication for weeks.”

Lasting Neurological Symptoms

Desai says that when those neuromuscular tissues are damaged, it can lead to “a series of health issues, including double vision, squinted eyes,droopy eyelids, headaches, and a foul smell.”

Plus, surgical debridement to remove the dead tissue may cause irritation and permanent (though accidental) brain damage.

Fungal Infections of the Nervous System

India’s Second Wave of COVID and Rising Black Fungus Infections

The COVID-19 pandemic has left many people around the world with weakened immune systems—the ideal conditions for the black fungus looking for a new host. India is currently at the center of that perfect storm.

According to theWorld Health Organization,India has reported over 27 million cases with more than 300,000 deaths as of May 26. However, Desai says that since census statistics tend not to be up to date, the numbers are probably much higher.

“You only know what you measure, and India is not measuring the entire population,” says Desai. “In some rural areas or poor communities where hospital facilities and access are limited, they might not be able to diagnose cases. So, the reporting of data in India is unfortunately skewed because you are not catching everything.”

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According to Desai, there is no direct scientific evidence that the SARS-CoV-2 virus itself is causing black fungus infections. It’s more likely that the black fungus cases in India are connected to two main factors:

Diabetes

According to Desai, India has been dealing with a diabetic epidemic for at least two decades—about 40% of the population in India has diabetes.

“People are walking around withuncontrolled diabetes, and then steroids are given to them, making diabetes worse, [and] which makes them more immunocompromised,” says Desai. “So, you have a double whammy, you have uncontrolled diabetics thrown on steroids or other immunosuppressants.”

A recent study published in “Diabetes & Metabolic Syndrome: Clinical Research & Reviews” found that 80% of black fungus cases involved patients with diabetes. About 76.3% of cases occurred in patients who were given steroids to treat COVID-19.

Steroid Use

Steroid treatments have become a mainstay of COVID-19 treatment because of the prolonged inflammation andcytokine stormthe virus induces in the body. There are specific indications for using steroids, but Desai says that the surge of COVID-19 cases has led to the overprescribing of steroids and other immunosuppressants without proper supervision.

“In India, the first reaction of general practitioners and regular doctors for COVID positive patients is to throw them on steroids,” says Desai. “The practicing pattern is to give them anything and everything they can.”

Will COVID Vaccines Help?

Beingfully vaccinatedwith one of the approved COVID-19 vaccines can make you less likely to get black fungus because you’re less likely to get severely sick from COVID. Avoiding the virus means that you won’t need to receive steroid treatment or immunosuppressive therapy—both of which put you in an immunocompromised state, as would getting sick with COVID in the first place.

Desai says that because social distancing andface mask-wearingare not always popular or feasible, given India’s crowded communities and population size, the country will have to rely heavily on immunization for controlling cases of COVID and black fungus infections.

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The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit ourcoronavirus news page.

3 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Centers for Disease Control and Prevention (CDC).Where Mucormycosis Comes From.Centers for Disease Control and Prevention (CDC).Mucormycosis Statistics.Singh AK, Singh R, Joshi SR, et al.Mucormycosis in COVID-19: A systematic review of cases reported worldwide and in India.Diabetes & Metabolic Syndrome: Clinical Research & Reviews. Published online May 2021. doi:10.1016/j.dsx.2021.05.019

3 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Centers for Disease Control and Prevention (CDC).Where Mucormycosis Comes From.Centers for Disease Control and Prevention (CDC).Mucormycosis Statistics.Singh AK, Singh R, Joshi SR, et al.Mucormycosis in COVID-19: A systematic review of cases reported worldwide and in India.Diabetes & Metabolic Syndrome: Clinical Research & Reviews. Published online May 2021. doi:10.1016/j.dsx.2021.05.019

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Centers for Disease Control and Prevention (CDC).Where Mucormycosis Comes From.Centers for Disease Control and Prevention (CDC).Mucormycosis Statistics.Singh AK, Singh R, Joshi SR, et al.Mucormycosis in COVID-19: A systematic review of cases reported worldwide and in India.Diabetes & Metabolic Syndrome: Clinical Research & Reviews. Published online May 2021. doi:10.1016/j.dsx.2021.05.019

Centers for Disease Control and Prevention (CDC).Where Mucormycosis Comes From.

Centers for Disease Control and Prevention (CDC).Mucormycosis Statistics.

Singh AK, Singh R, Joshi SR, et al.Mucormycosis in COVID-19: A systematic review of cases reported worldwide and in India.Diabetes & Metabolic Syndrome: Clinical Research & Reviews. Published online May 2021. doi:10.1016/j.dsx.2021.05.019

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