Is Mucormycosis an inevitable complication of Covid-19 in India?

Abstract

Mucormycosis or black fungus infection is a less common disease but highly fatal infection, infecting the immunocompromised individuals. The site of predilection of the fungus is found to be lungs and brain in addition to its sequestration in sinusoidal spaces. Presently with the ongoing COVID 19 pandemic, the prevalence of this infection is found to be high in the Indian population. The fungus establishes itself by affecting the compromised immune system of an individual and thereby making the individual susceptible to other diseases/infection. The reasons attributed to the sudden upsurge are steroidal therapeutics abuse, tocilizumab therapy and diabetes mellitus.To avert the cytokine storm, the medical health workers are necessitated to include steroid drugs in COVID 19 treatment protocol however inclusion of these drugs in patients who do essentially require steroids can have their immune system debilitated and permit the invasion of this fungus. According to International Diabetes Federation (IDF), 77 million Indians are known to be diabetic, cautioning the physicians to be vigilante of the impending black fungus infection in the event of COVID19 affliction in such individuals. There is causal relationship between anti-hyperglycemic drugs and weakened immune system and opportunity for the fungus invasion. This review attempts to explain the inter-relatedness of COVID19 infection, its treatment and eventual black fungus infection risk.

COVID-19–associated mucormycosis: Evidence-based critical review of an emerging infection burden during the pandemic’s second wave in India

“…Tocilizumab, an anti-IL-6 receptor monoclonal antibody, is the only immunosuppressant mentioned in the Indian guidelines on the COVID-19 management algorithm for off-label use [ 65 ]. Increased use of tocilizumab in patients with COVID-19 for inflammation control can reduce patient immunity and pose a significant risk for contracting CAM [ 66 – 68 ]. The use of an antifungal agent, voriconazole, in Mucorales-related infections does not yield efficacy; instead, it can lead to breakthrough mucormycosis infection.…”

“…Neutropenia, leading to reduced intact immunity, is a risk factor for mucormycosis; thus, immunocompetent individuals do not become affected by it [ 47 ]. The unhygienic handling of oxygen or inferior tubing, contaminated masks, an impure water source used in humidifiers, and the use of the same oxygen mask for more than 2 patients for a longer period are also reported to be the causes of concern [ 66 , 70 ]. However, the involvement of humidifier water as the source is debatable.…”

Growth of Aspergillus and Mucor spp. in sputum culture of a post-COVID patient: fungal infection or colonization? A clinical challenge in COVID-era

“…Mucormycosis and other opportunistic infections among patients suffering and recovering from COVID-19 have emerged as a challenging health issue throughout the globe, specially more in India. [4][5][6] A case of post-COVID pulmonary mucormycosis is reported from Bangladesh 7 and to our knowledge, few more cases are diagnosed (un-published). Several factors are responsible for such an increased incidence of invasive fungal infections among patients recovering from COVID-19, which include severe pulmonary alveolar damages in COVID-19 that facilitate fungal invasion, immune dysregulations in COVID-19, invasive mechanical ventilations may facilitate entry of opportunistic pathogens, immunosuppressive drugs used in COVID-19, prolonged hospital stay and injudicious antibiotic prescription.…”

New Antifungal Compound: Impact of Cosolvency, Micellization and Complexation on Solubility and Permeability Processes

“…The solubilizing potential of cyclodextrins towards S-119 antifungal was evaluated using the stability constants (K S ) of the complexes derived from the phase solubility profiles (Figure 3) calculated by Equation (1). According to the Higuchi and Connors classification [35], at both pHs, the phase solubility diagrams for α-CD, HP-β-CD and O-M-β-CD are of A L -type, indicating the formation of soluble complexes.…”

“…Pathogenic fungi actively mutate and become increasingly resistant to the drugs used. They are especially dangerous for people with weakened immunity, in particular, for those who have had a coronavirus infection and who have taken steroids and immunosuppressant for treatment [1].…”