Black Fungus Mutilating COVID-19 Pandemic in India: Facts and Immunological Perspectives

While the world is still struggling with the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, an aggressive and rare fungal infection which is commonly ascribed as the black fungus has emerged as a new medical challenge in India. India had already experienced the devastating consequences of the COVID-19 and, being a rare "opportunistic" fungal infection, black fungus infection has severely complicated the post-COVID-19 recoveries. Together with the uncertain treatment modalities at the beginning of the pandemic, indiscriminate use of a plethora of medications has driven the surging cases of black fungus-associated complications. Moreover, low oxygen, high iron levels, and prolonged hospitalization with mechanical ventilators created a superlative condition for contracting black fungus infection. The disease mainly spreads through the respiratory tract and erodes facial structures. Since mucormycosis specifically attacks immunosuppressed patients, the disease started spreading rapidly, with an average mortality rate of 54 %. Common symptoms include blackening over the nose, blurred or double vision, breathing difficulties, chest pain and hemoptysis. Although not contagious, the outcome of the disease is often very frightful. If the infection disseminates systematically, the risk of affecting the vital organs such as the spleen and heart is substantially high. We have tried to provide an epidemiological overview of black fungus infection in India. We focused on drawing a comprehensive fact check of the current situation through an immunological perspective to better understand the infection as a major co-infection in patients affected by COVID-19 and its impact on India's fight against the COVID-19 pandemic. Keywords: Black fungus, COVID-19, Mucormycosis, Epidemiology, India