COVID-Associated Mucormycosis: Review of Cases Reported Worldwide and in India

Abstract

Objective: The aim of this review literature is to collate and analyse various case reports and series reporting mucormycosis in COVID and post-COVID patients in India and worldwide. Methods: A systematic literature search was conducted from December 2019 to June 2021 using keywords. Details of all the case reports/ series that reported rhino-orbital-cerebral mucormycosis in COVID and post-COVID settings were retrieved and analysed. Results: In this systematic review, 33 articles were included and a total of 181 cases of mucormycosis in COVID and post-COVID patients were reported. Mucormycosis was predominantly seen in males (71.2%) as compared to females (28.7%). History of steroid use was present in 113 patients (62.4%). Type 2 diabetes mellitus was the most common independent risk factor, present in 138 patients (76%). Sino-nasal involvement was seen in 27 patients (14.9%), rhino-orbital involvement in 114 patients (62.9%), andrhino-orbital-cerebral involvement was observed in 40 patients (22%). Improvement in clinical status was observed in 106 patients (58.5%) while 38 patients (21%) expired. Conclusions: A rapid rise in cases of mucormycosis had been reported in the COVID era. Unwarranted use of steroids coupled with uncontrolled hyperglycemia, unregulated activation of inflammatory mediators and overactivation of entry-point receptors inflicted by the Coronavirus cause a state of immune dysregulation, leading to opportunistic invasive fungal infections. A delay in diagnosis can result in disfigurement, functional loss, or even death. Multidisciplinary management with prompt reversal of risk factors is recommended.