MUCORMYCOSIS: A NEW EMERGING CONTESTANT DURING COVID-19 PANDEMIC

MUCORMYCOSIS: A NEW EMERGING CONTESTANT DURING COVID-19 PANDEMIC  

1. What is Mucormycosis or black fungus is?

Mucormycosis is a type of fungal infection. It’s relatively rare and sometimes life-threatening if not diagnosed timely and treated properly. It is a very rare type of infection that is spread by an opportunistic fungus (aka Black fungus) found in the environment – soil, plants, fertilizers, and rotten fruits and vegetables. Here are some types of black fungus Rhizopus Species (sp.), Mucor sp., and others include Rhizomucor sp. etc. The fungus is found everywhere, in the soil, in the air, and even in the noses of healthy and people with uncontrolled diabetes mellitus. It affects the nasal passages, sinuses (a cavity within a bone or other tissue, especially one in the bones of the face or skull connecting with the nasal cavities), vital organs such as brain and lungs and can be fatal for uncontrolled diabetic patients or people with very weak immune systems such as AIDS or cancer, on dialysis.

2. Type of mucormycosis

1. Rhinocerebral mucormycosis: brain, nasal sinuses, nose, eyes are affected

2. Pulmonary mucormycosis: lungs are affected

3. Gastrointestinal mucormycosis: when stomach and GIT is affected

4. Cutaneous mucormycosis: skin abscess, wounds are affected

5. Disseminated mucormycosis: infect the neutropenic patients with hematologic malignancies, post transplants or in patients on deferoxamine therapy

3. Etiology

1. Diabetes Mellitus (especially uncontrolled DM)

2. Patients on steroids

3. Low immunity

4. Other infections like HIV, TB or cancer

5. Using air coolers

4. Relationship between COVID-19 and mucormycosis

There are increasing reports of mucormycosis (black fungus infection) in the literature that people on steroids therapy (dexamethasone etc.), such as COVID-19 patients, develop secondary infections by some species of opportunistic fungus, which ultimately leads to the death of COVID-19 patients.

It is believed that cases of black fungus infections are increasing due to the high use of steroids in COVID19 patients. About 50-54% of people with disease die, it is many times more lethal than coronavirus whose mortality is 2%. Furthermore, a systematic review conducted by Iranian researchers had reported 100% mortality in their study. However, the sample size was too small that is not enough to generalize the results over population but the study is fairly highlighting that how mucormycosis can increase the rate of mortality in COVID-10 patients.

5. Mechanism of mucormycosis

Inflammation cause tissue damage in the body and steroids decrease the inflammation by reducing the ability of white blood cells to help produce chemicals that can cause inflammation. In addition to reduction in inflammation, steroids also affect the way white blood cells work and compromise the immune system to become weaken and run slow. Black fungus takes advantage of this compromised immunity and cause mucormycosis, which can lead to death in COVID-19 patients.

6. Diagnosis of mucormycosis

1. The Mucormycosis can be diagnosed by collecting a sample of fluid from your respiratory system and sample is then sent to a laboratory to test by different ways; also including RT-PCR using mucormycosis specific primers.

2. Tissue biopsy.

3. MRI/ CT Scan

7. Treatment of mucormycosis

The treatment of mucormycosis is antifungal drugs; which is much expensive treatment and takes longer time. 

Some common antifungal medications that physicians may prescribe for mucormycosis include:

1. Amphotericin B

2.  Posaconazole

3. Isavuconazole

Note:  Self-medication is equal to suicide sometimes so, we do not recommend using these antifungal drugs on you own observations.

8. Precautionary measurments

Precautions includes all that are recommended for COVID-19 during this pandemic.

 

References

1. https://www.google.com/amp/s/www.bbc.com/news/world-asia-india-57027829.amp
2. https://www.google.com/amp/s/amp.theguardian.com/global/2021/may/11/what-is-the-dangerous-black-fungus-being-seen-in-covid-patients-in-india-mucormycosis
3. https://www.google.com/amp/s/www.cnbc.com/amp/2021/05/11/india-covid-crisis-mucormycosis-fungal-infection.html
4. https://my.clevelandclinic.org/health/drugs/4812-corticosteroids
5. https://www.cdc.gov/fungal/diseases/mucormycosis/causes.html
6. https://www.healthline.com/health-news/black-fungus-is-appearing-in-people-with-covid-19-what-to-know#Aspergillosis-infection-of-particular-concern
7. Ahmadikia, K., Hashemi, S. J., Khodavaisy, S., Getso, M. I., Alijani, N., Badali, H., ... & Rezaie, S. (2021). The double‐edged sword of systemic corticosteroid therapy in viral pneumonia: A case report and comparative review of influenza‐associated mucormycosis versus COVID‐19 associated mucormycosis. Mycoses.
8. Moorthy, A., Gaikwad, R., Krishna, S., Hegde, R., Tripathi, K. K., Kale, P. G., ... & Bonanthaya, K. (2021). SARS-CoV-2, Uncontrolled Diabetes and Corticosteroids—An Unholy Trinity in Invasive Fungal Infections of the Maxillofacial Region? A Retrospective, Multi-centric Analysis. Journal of Maxillofacial and Oral Surgery, 1-8.
9. Hrncirova, K., Lengerova, M., Kocmanova, I., Racil, Z., Volfova, P., Palousova, D., ... & Mayer, J. (2010). Rapid detection and identification of mucormycetes from culture and tissue samples by use of high-resolution melt analysis. Journal of clinical microbiology, 48(9), 3392-3394.