Decoding the potential link between Covid-19 and mucormycosis: Literature review

Abstract

Background: Mucorales, the causative agent of mu-cormycosis, is a life-threatening fungal infection that primarily affects immunocompromised hosts. This condition is becoming more severe during the current COVID-19 pandemic. The objective is to decipher the link between mucormycosis, steroids, and the associated co-morbidities of COVID-associated mucormycosis (CAM). This study is focussed on assessing the various aspects of COVID related mucormycosis. Aim: To systematically review the reported cases of CAM, clinical presentation with steroid therapy and associated comorbidities.
Materials and Methods: MeSH terms like mucormycosis, diabetes, SARS-CoV-2 infection, sinus, orbit, and palate were searched in the PUBMED and Google Scholar databases, and 20 case reports and case series were identified.
Results: We found that India had the highest number of cases (60%), 55% of the infected patients were male, 65% had a history of diabetes and the associated risk factor was uncontrolled diabetes (90%). The common clinical presentation among the cases was noted to be necrosis and swelling, with 55% of the cases reported to be rhino orbital mucormycosis. In most of the cases cytological and histological examination had been performed with haematoxylin & eosin, KOH, lactophenol cotton blue, and special stains such as PAS and GMS had been used in few cases along with culture in Sabouraud dextrose agar. Regarding treatment, 85% of the cases were treated with amphotericin B and in 15% of cases a combination of amphotericin B and posaconazole was employed. The rate of mortality reported was estimated to be 25%.
Conclusion: COVID-19 infection poses a significant threat to diabetic patients, increasing their susceptibility to mucormycosis. Therefore, the careful use of steroids and routine monitoring are essential in preventing this invasive infection.