The double trouble: COVID-19 associated mucormycosis a focused review and future perspectives

Abstract

Mucormycosis, a deadly fungal infection, has affected thousands of COVID-19 patients in India. Mucormycosis, formerly known as zygomycosis, is caused by the many fungi that belong to the family “Mucorales.” These molds are commonly found in soil, air, and damp walls and frequently colonize oral mucosa, nose, paranasal sinuses, and throat. The pathophysiological consequences of diabetes combined with the acute inflammatory surge in COVID-19 and steroid treatment weakens person’s immunity and renders susceptibility to fungal infections. Patients treated for severe COVID-19 have damaged lungs and suppressed immune system, an environment that supports fungal infection. Fungal spores can grow in airways or sinuses, and invade bodies’ tissues, explaining why the nasal cavity and paranasal sinuses are the most common site of mucormycosis infection, the consequential spread to the eyes can cause blindness, or causing headaches or seizures if the infection spreads to the brain. Poorly controlled diabetes often results in acidosis in tissues a suitable environment for Mucorales fungi to grow, exacerbating the risk for mucormycosis. This becomes clinically important, especially in India that has an increased prevalence of undiagnosed and uncontrolled diabetes. Given that a significant increase in the cases of mucormycosis in the diabetic patients treated for COVID-19 is strongly associated with corticosteroid administration, there is a need to evaluate use of dietary nutraceuticals with immune boosting potentials that modulate metabolic abnormalities in the management of COVID-19 associated mucormycosis.