The pandemic coronavirus disease 2019 (COVID-19) continues to be a significant problem globally. Mucormycosis is not so common but serious fungal infection that complicates the course of severe COVID-19. The elderly and people with preexisting diseases (diabetes, cardiovascular disease, and cancer) are the most susceptible and may be at a higher risk for developing mucormycosis.
Is there any relation between Covid-19 and mucormycosis
While various treatment options have been evaluated, none except systemic glucocorticoids have been shown to enhance survival in COVID-19. Concurrent glucocorticoid therapy probably intensify the risk of mucormycosis. Unfortunately, the widespread use of glucocorticoids can lead to secondary bacterial or fungal infections(3). Usually refers to as opportunistic infections (OIs).
The article published in the Journal of fungi mentioned that the release of danger-associated molecular patterns during severe COVID-19 results in both pulmonary epithelial damage and inflammatory disease, which are predisposing risk factors for pulmonary aspergillosis. Moreover, it points out the possibilities of a highly permissive inflammatory environment that favors fungal pathogenesis as a result of weakened immunity(4). Here comes the tremendous possibilities of the emergence of other opportunistic infections such as mucormycosis. Eventhough, mucormycosis is uncommonly suspected or diagnosed the danger behind could be life threatening. Herein, we report a case of pulmonary mucormycosis in a patient with severe COVID-19.
Glucocorticoids and probably remdesivir are the only drugs proven to be beneficial in COVID-19. Glucocorticoids are inexpensive, widely available, and have been shown to reduce mortality in hypoxemic patients with COVID-19. Nevertheless, glucocorticoids can increase the risk of secondary infections. Moreover, the immune dysregulation caused by the virus and the use of concurrent immunomodulatory drugs such as tocilizumab could further increase the risk of infections in COVID-19 patients (3).
Invasive mold infections (invasive pulmonary aspergillosis and pulmonary mucormycosis) share similar risk factors, clinical presentation, and radiology. The diagnosis of CAM is thus even more challenging. A lack of clinical suspicion and difficulty isolating the causative fungi might contribute to the under diagnosis of mucormycosis.
The biomarkers such as beta-d-glucan and galactomannan, which aid in diagnosing invasive aspergillosis, are not available for mucormycosis. Diabetes mellitus has been associated with severe COVID-19. Those with diabetes are at an increased risk of death than those without. Further, poorly controlled diabetic patients may have overt or covert renal dysfunction. The presence of multiple risk factors or comorbid illnesses in severe COVID-19 patients, along with the additional immunosuppression caused by glucocorticoids, increases the net state of immune suppression, thereby predisposing them to invasive mold infections.
How is mucormycosis treated?
Mucormycosis is a serious infection and needs to be treated with prescription antifungal medicine, usually amphotericin B, posaconazole, or isavuconazole. These medicines are given through a vein (amphotericin B, posaconazole, isavuconazole) or by mouth (posaconazole, isavuconazole). Other medicines, including fluconazole, voriconazole, and echinocandins, do not work against fungi that cause mucormycosis. Often, mucormycosis requires surgery to cut away the infected tissue (1).
What are the precautions to be taken?
Make sure to practice all hygienic measures
Disinfect your masks after each use
Clean your face and eyes after removing your masks
Take precautions while taking steam inhalation
Excessive steam inhalation may lead to mild burns in the mucosal membrane
Future Recommendations
Increase the rate of hospital based autopsies. Autopsies are rarely performed, which may result in an underestimation of the prevalence of mucomycosis and other infections
Urgent measures to curtail the non evidence based misuse of antibiotics
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