Abstract
The coronavirus disease 2019 (COVID-19) outbreak has caused significant destruction, claiming over three million lives worldwide. Post SARS-COV-2 invasion, immunosuppression with hyperglycemia and elevated ferritin levels along with steroidal treatment creates a perfect storm for opportunistic infections. There is increasing evidence of mucormycosis co-infection in COVID-19 patients, during or post-treatment. A worse prognosis, a late diagnosis, and limited guidelines of screening and management of COVID-19 associated mucormycosis have made healthcare professionals fear an epidemic alongside a pandemic. This review geographically reports cases of COVID-19 associated mucormycosis (CAM), evaluates characteristics, clinical manifestations, and outcomes of mucormycosis in COVID-19 active or recovered patients. It further describes preventive strategies and recommendations for optimal management therapy that can be adopted worldwide to curtail an impending threat to the healthcare system.
Highlights
The novel severe acute respiratory syndrome coronavirus-2 (SARS CoV-2) first reported in Wuhan, China on 21 December 2019 [1,2]
These include hypoxia, high glucose levels due to diabetes or steroid-induced hyperglycemia, acidic medium created by diabetic ketoacidosis or metabolic acidosis, high ferritin levels due to inflammation, and a decreased activity and count of white blood cells along with several underlying conditions that promote the germination of spores and lead to the catastrophic picture of rhino cerebral mucormycosis co-infection with COVID-19 [18]
We have summarized the pathophysiology, clinical manifestations, diagnosis, and management of mucormycosis associated with COVID-19, and provided a summary of all cases published in the literature
Summary
The novel severe acute respiratory syndrome coronavirus-2 (SARS CoV-2) first reported in Wuhan, China on 21 December 2019 [1,2]. The Rhizopus oryzae is the most common type and responsible for nearly 60% of mucormycosis cases in humans and accounts for 90% of the Rhino-orbital-cerebral (ROCM) form [17] These fungi live in soil and in decaying organic matter, such as leaves, compost piles, or rotten wood. There has been a rise in the number of cases of mucormycosis in patients with COVID-19 worldwide, in India The reason behind this is the favorable environment in the affected patient that allows the spores to grow. These include hypoxia, high glucose levels due to diabetes or steroid-induced hyperglycemia, acidic medium created by diabetic ketoacidosis or metabolic acidosis, high ferritin levels due to inflammation, and a decreased activity and count of white blood cells along with several underlying conditions that promote the germination of spores and lead to the catastrophic picture of rhino cerebral mucormycosis co-infection with COVID-19 [18]. We have summarized the pathophysiology, clinical manifestations, diagnosis, and management of mucormycosis associated with COVID-19, and provided a summary of all cases published in the literature
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