COVID-19 and the alarming rise of "black fungus" (mucormycosis) infection.

COVID-19 which first raised its deadly head in December 2019, has now engulfed the entire planet with its fire and fury. Mankind has been literally held to ransom by this micro-beast which has caused so much pain, sorrow and suffering, leaving behind scores of people dead and millions sick and gasping for air (quite literally!) The whole world is in disarray since the past 16 months, and now a new deadly superadded fungal infection has appeared in COVID-19 patients, in parts of the Indian subcontinent; namely mucormycosis, the deadly "black fungus." This persistent, unrelenting fungal infection which is relatively resistant to conventional anti-fungal treatment, sometimes requires radical, extensive surgical intervention in order to stem the spread of infection to vital organs such as the heart, brain, orbital spaces and spleen. mucormycosis has been increasingly seen to occur in COVID-19 patients who are immunocompromised and have uncontrolled diabetes mellitus as a comorbidity. Commonly seen forms of mucormycosis in COVID-19 patients include, Rhinocerebral mucormycosis and Pulmonary mucormycosis, with some patients also developing the cutaneous form, while some manifesting the more serious disseminated form of mucormycosis.

Omicron: the highly mutational COVID-19 variant with immune escape.

In the latter-half of 2021, as people all over the world began optimistically thinking that reopening was just a heartbeat away, providence meant otherwise, and the world was once again hit by a COVID-19 variant; this time with a record number of 32 mutations across its spike proteins and significantly increased transmissibility, infectiousness and immune escape. The WHO subsequently named this variant the "Omicron variant," after yet another new Greek alphabet. Subsequently, it has been observed that the reinfection (evasion of immunity derived from prior infection) risk from the Omicron variant of the SARS-CoV-2 virus is substantially higher than from the previously identified beta and delta variants. South African researchers have found preliminary results suggesting significant and ongoing increase in the risk of reinfection with the Omicron variant in patients who previously suffered from COVID-19 infection.

Increasing incidence of lung transplantation in patients with post-COVID-19 pulmonary fibrosis.

Twenty months into the COVID-19 pandemic, we are still learning about the various long-term consequences of COVID-19 infection. While many patients do recover with minimal long-term consequences, some patients develop irreversible parenchymal and interstitial lung damage leading to diffuse pulmonary fibrosis. Unfortunately, these are some of the consequences of post-SARS-CoV-2 infection which thousands more people around the world will experience and which will outlast the pandemic for a long time to come. It is now being observed at various leading medical centres around the world that lung transplantation may be the only meaningful treatment available to a select group of patients experiencing serious lung damage and non-resolving COVID-19-associated respiratory failure, resulting from the triad of coronavirus infection, a hyper-inflammatory immune response to it and the inability of the human body to repair that injury.

Recurrent haemoptysis.

A man, 56 years of age, presents to his general practitioner after coughing up half a cupful of fresh, bright red blood every day for 1 week. He has no other medical complaints. He reports previous pulmonary tuberculosis 12 years ago treated with 6 months of standard therapy. Routine follow up was discontinued after 5 years after no evidence of reactivation. He is a nonsmoker, does office clerical duties and is not known to have diabetes or hypertension.

A tile factory worker presenting with breathlessness and dry cough.

Jenny, a nonsmoker, 54 years of age, presents with 3 years of dry cough, progressive breathlessness and reducing exercise tolerance. Two years ago she was diagnosed with asthma and treated with inhaled bronchodilators (which have been marginally effective). Jenny has worked in a tile factory for 22 years; 15 years in the grinding department, transferring to the chipping department 7 years ago. On examination she is tachypnoeic with a prolonged expiratory phase. There are bilateral rhonchi and a few fine crepitations at the left infrascapular region. Jenny's full blood count and electrocardiogram are normal. Arterial blood gas show mild hypoxia with respiratory alkalosis. Spirometry demonstrates mixed moderate obstructive and restrictive impairment. The diffusion capacity for carbon monoxide is reduced. Mantoux is negative and erythrocyte sedimentation rate is 10 mm/hour. A chest X-ray is taken.