Green Fungus

Amidst the second wave of coronavirus infection in India, an alarming rise in cases of several fungal infections in post COVID patients have been an additional cause for concern.

After the Black, Yellow and White Fungus, cases of Green Fungus disease have now been reported. The Green Fungus was found in the lungs of a 34-year-old COVID-19 survivor in Indore, Madhya Pradesh. Later, the first confirmed case was reported in Jalandhar, Punjab.

What is Green Fungus?

Green Fungus disease is Aspergillosis. It is caused by Aspergillus fungus, which belongs to the Molds group of fungi. It is found both outdoors and indoors, widely distributed on decaying organic matter and insulation ducts. Although the spores of this fungus are present throughout nature, they usually do not cause problems. Most people breathe in (inhale) these spores on a daily basis, but do not fall sick. This is because the immune system of a normal person is competent enough to fight the fungus and eliminate them from the body. However, this is not the case in people with weakened immune systems. When the immunity is compromised, one may fall prey to this infection.

What are the Types of Green Fungus?

• Pulmonary Aspergillosis:
• Allergic Bronchopulmonary Aspergillosis (ABPA) - It occurs due to an allergic response to the fungal spores that are breathed in. The symptoms exhibited in this type of Aspergillosis are similar to those of Asthma.
• Chronic Cavitary Pulmonary Aspergillosis - This variant of Pulmonary Aspergillosis is seen when the fungus has been present in the lungs for a long time. It leads to formation of empty spaces or cavities in the lungs. It can also cause expansion of pre-existing cavities due to other lung diseases like Tuberculosis.
• Allergic Aspergillus Sinusitis - It occurs when the fungus affects the sinuses and causes allergic and inflammatory manifestations.
• Aspergilloma (fungal ball) - It is seen when a fungal ball grows in the lungs or the sinuses. A fungal ball is an aggregation of fungal fibres, along with mucus, inflammatory cells, fibrin and some tissue debris.
• Invasive Aspergillosis - It is the most severe form of Aspergillosis, which occurs when Aspergillus fungus causes a serious infection in people with severely weakened immune systems. The fungal infection can also spread to other organs leading to failure of multiple organs.
• Cutaneous Aspergillosis - The skin can sometimes be affected if the fungus gains access post injury or a surgery. It can also occur, if the infection spreads to the skin from elsewhere in the body.
• Others - Many organs can get affected like - Ocular Aspergillosis, Ear infections, Brain abscesses, Gastrointestinal Aspergillosis.

What are the Causes and Risk Factors of Green Fungus?

A weakened immune system makes a person vulnerable to fungal infections. In COVID survivors, the immunity gets compromised to a great extent. The use of long term or high dose steroids can further compromise the immune response of the body, thereby creating an opportunity for these fungal infections to flare up.

Moreover, patients with underlying lung diseases like COPD (Chronic Obstructive Pulmonary Disease), Sarcoidosis and Cystic Fibrosis already have a compromised lung condition and this makes them more prone to such infections.

Other significant at-risk groups include patients receiving Cancer Therapy, post Hematopoietic Stem Cell Transplant (HSCT) and those on long term immunosuppressant medicines.

What are the Symptoms of Green Fungus?

The symptoms of Green Fungus disease depend on the type of infection:

• Allergic Bronchopulmonary Aspergillosis (ABPA):
  • Cough
  • Shortness of breath
  • Noisy breathing (Wheezing)
• Chronic Pulmonary Aspergillosis:
  • Cough
  • Shortness of breath
  • Weakness
  • Weight loss
  • Coughing up blood (Haemoptysis)
• Allergic Aspergillus Sinusitis:
  • Runny nose
  • Stuffiness of nose
  • Headache
  • Reduced smell
• Aspergilloma (Fungal Ball):
  • Cough
  • Shortness of breath
  • Coughing up blood
• Invasive Aspergillosis:
  • High fever
  • Coughing up blood
  • Nose bleeding
  • Shortness of breath
  • Weight loss

How to Diagnose Green Fungus?

When a case of Green Fungus is suspected on clinical examination, several diagnostic tests are performed in order to confirm the diagnosis. The workup that may be done in such cases include the following tests:

1. Histopathology: A sample is collected from the respiratory tract of the patient either by obtaining sputum (coughed up mucus from the respiratory tract) or by performing a Bronchoalveolar Lavage (BAL). The sample is then examined by a pathologist under the microscope in a lab to identify the presence of the fungus. A lung biopsy can also be performed, where a tissue sample is surgically obtained from the lungs, which is then studied.
2. Antigen and Antibody detection: Blood samples are tested for specific antigens and antibodies specific to the fungus.
3. Radiology: It helps to localise the disease and also to detect characteristic findings like fungal ball or cavities in lungs. The commonly used imaging modalities are:
   1. Chest Radiograph
   2. CT scan
4. IgE titres: If the disease is of allergic origin, the specific IgE levels in the blood are elevated.

How to Treat Green Fungus?

The treatment of this disease includes the use of antifungal medicines like Itraconazole, Voriconazole, Amphotericin B and Caspofungin.

An Aspergilloma (fungal ball) may be removed surgically by the doctor.

A case of Invasive Aspergillosis may require tapering the doses of ongoing immunosuppressant medicines.

How to Prevent Green Fungus Infection?

Green Fungus is not contagious, thus cannot be transmitted from one person to another.

But the spores are easily inhaled by us from the surroundings. Hence, in order to protect ourselves from this fungal infection, we should take a few precautions:

1. Maintaining a good hygiene, oral and physical cleanliness.
2. As much as possible, areas with a lot of dust, soil, or stored contaminated water should be avoided.
3. Face masks (N95 mask) should be used if such areas cannot be avoided.
4. Hands and face should be thoroughly washed with soap and water if exposed to probable contaminated areas.
5. Use of long pants, full sleeved shirts, shoes and gloves are recommended while gardening.
6. Maintaining a healthy and nutritious diet in order to build immunity.

References:

1. Aspergillosis - https://rarediseases.org/rare-diseases/aspergillosis/
2. Types of Fungal Disease - Aspergillosis - https://www.cdc.gov/fungal/diseases/aspergillosis/index.html
3. Know More About Aspergillosis - https://www.ncbi.nlm.nih.gov/books/NBK482241/

Cite this Article ⇣⇡

Please use one of the following formats to cite this article in your essay, paper or report:

• APA

  Dr. Sreeja Dutta. (2021, June 28). Green Fungus or Aspergillosis and COVID-19 Infection. Medindia. Retrieved on Apr 27, 2024 from https://www.medindia.net/health/conditions/green-fungus.htm.

• MLA

  Dr. Sreeja Dutta. "Green Fungus or Aspergillosis and COVID-19 Infection". Medindia. Apr 27, 2024. <https://www.medindia.net/health/conditions/green-fungus.htm>.

• Chicago

  Dr. Sreeja Dutta. "Green Fungus or Aspergillosis and COVID-19 Infection". Medindia. https://www.medindia.net/health/conditions/green-fungus.htm. (accessed Apr 27, 2024).

• Harvard

  Dr. Sreeja Dutta. 2021. Green Fungus or Aspergillosis and COVID-19 Infection. Medindia, viewed Apr 27, 2024, https://www.medindia.net/health/conditions/green-fungus.htm.