Mucormycosis in this COVID times- A case series

Abstract

Mucorales are fast-growing thermostat fungi that are ubiquitous in environment. Most common form is rhino-orbito-cerebral mucormycosis. It is the third most common cause of invasive fungal infections following asperigillosis and candidiasis. Their incidence has increased in recent times, especially in the 2 wave of COVID-19 in India. COVID-19 is caused by non-segmented negative sense RNA virus, which causes profound lymphopenia. Glucocorticoid has emerged as main treatment of choice for COVID-19 patients with severe symptoms. The patients of COVID-19 are increasingly affected with mucormycosis because of decreased immunity, impaired defense mechanisms, dysfunctional lymphocytes and neutrophils, and injudicious use of glucocorticoids. Diabetes mellitus is an independent risk factor for both mucormycosis and severe COVID-19. Hyperglycemia due to diabetes and glucocorticoid increases the incidence of infection due to greater availability of glucose to the pathogen, lower response of T cells, and acidic Ph. This fungus has predilection to invade blood vessels leading to extensive necrosis (black eschar). The overall mortality rate is 56%. Mortality depends upon underlying health condition of patient and the part of the body affected.In this retrospective study, we present an interesting case series of 15 patients with mucormycosis. Association with diabetes, with uncontrolled glycemic index was found in all the cases. COVID-19 associated mucormycosis was seen in 10 patients.Excessive use of corticosteroid in a patient with COVID-19 has aggravated the scenario. An early foresight about the condition and judicious use of steroids is useful. So, an early diagnosis and prompt treatment of mucormycosis can decrease the fatality and morbidity in patients.