Are Unique Regional Factors the Missing Link in India’s COVID-19-Associated Mucormycosis Crisis?

Abstract

The exact cause of the disproportionate increase in COVID-19-associated mucormycosis (CAM) cases in India remains unknown. Most researchers consider the major cause of India’s CAM epidemic to be the conjunction of the COVID-19 pandemic and associated corticosteroid treatment with the enormous number of Indians with diabetes mellitus (DM). However, excess CAM cases were not seen to the same extent in the Western world, where diabetes is prevalent and corticosteroids are also used extensively for COVID-19 treatment.

Could cattle dung burning have contributed to the epidemic of COVID‐19‐associated mucormycosis in India? Results of an experimental aero‐mycological study

“…Few media reports of cattle dung application over the body 15 and the use of cattle dung cakes for cremation 16 led to a hypothesis that the inhalation of fumes after burning cattle dung contributed to the CAM outbreak in India. 10 We found Mucorales in the ambient air even before burning the cattle dung cakes that did not change significantly during or after combustion. The growth of Lichtheimia from fresh dung samples indicates that fresh dung application over the body or its ingestion could potentially lead to mucormycosis.…”

“…What do our study results imply? Few media reports of cattle dung application over the body 15 and the use of cattle dung cakes for cremation 16 led to a hypothesis that the inhalation of fumes after burning cattle dung contributed to the CAM outbreak in India 10 . We found Mucorales in the ambient air even before burning the cattle dung cakes that did not change significantly during or after combustion.…”

“…There was a hypothesis linking CAM to the inhalation of fumes after burning cattle dung cakes. 10 , 11 , 12 While burning various kinds of biomass (dry grass, leaves, twigs and flood detritus) in experimental conditions has shown to disperse fungal spores, 13 it is unknown whether combustion of cattle dung cake results in the dispersion of Mucoralean spores. We hypothesised that burning cattle dung cakes will be associated with a greater Mucorales burden in the air.…”

“…As India accounted for most cases of CAM, it was speculated that certain practices unique to the subcontinent were responsible for the outbreak. There was a hypothesis linking CAM to the inhalation of fumes after burning cattle dung cakes 10–12 . While burning various kinds of biomass (dry grass, leaves, twigs and flood detritus) in experimental conditions has shown to disperse fungal spores, 13 it is unknown whether combustion of cattle dung cake results in the dispersion of Mucoralean spores.…”

Neues aus der Reisemedizin

“…Ein kürzlich veröffentlichtes Paper 1 vermutet nun kulturell-religiöse Gründe für die außergewöhnlich hohen Fallzahlen in Indien: Bei den Mucorales handelt es sich um eine Pilzordnung, die besonders im Kot von Pflanzenfressern gedeiht. Und in Indien – dem Land mit der weltweit größten Rinderpopulation, in dem Kühe als heilig gelten – wird Kuhdung in zahlreichen Ritualen und auch als Kraftstoff verwendet.…”