Mucormycosis-The New Threat in Post-COVID 19 Infection (Review Article)

Author(s): Maitrayee Banerjee1 and Dolan Das

Abstract: Mucormycosis is the disease caused by the filamentous fungi that belong to the fungal family Mucorales. The Mucorales are considered as opportunistic fungi which can infect people with a compromised immune system. Patients on immunosuppressants as seen with organ recipients and hematological stem cell recipients are susceptible for mucormycosis. COVID-19 infection may induce significant and persistent lymphopenia, which in turn increases the risk of opportunistic infections. Patients with severe COVID-19 have distinctly lower absolute number of T lymphocytes, CD4+T and CD8+ T cells. Since the lymphocytes play a major role in maintaining the immune homeostasis, the patients with COVID-19 are highly susceptible to fungal co-infections. Uncontrolled glycemic load in diabetic patients during COVID infection may put them in higher risk for developing mucormycosis. Corticosteroid administration during COVID 19 infection also leads to impaired immune function and alteration in glucose homeostasis. These angioinvasive fungi invade the surrounding blood vessels and cause tissue necrosis. Awareness, early diagnosis, post-covid follow up and aggressive treatment is necessary for prevention of this life-threatening disease. Glycemic control, minimizing the prescription of steroids and immunosuppressive drugs must be taken in account in diagnosed patients. As the growth of fungus is dependent on availability of iron, sequential investigation of serum ferritin level and total iron binding capacity of patients is also recommended. Till now Amphotericin B is the first line drug of choice in India, subsequently anti-mucorales drug Posaconazole and Isavuconazole are also prescribed.

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