Mucormycosis in COVID-19 pandemic: Risk factors and linkages

Abstract

Mucormycosis is a serious and potentially fatal fungal infection caused by a type of rare but opportunistic fungal pathogen called mucormycetes. Recently, mucormycosis, also known as black fungus, made severe chaos in India during the second wave (between April and June 2021) of the tragical COVID-19 epidemic by its sudden and devastating surge with up to 50% mortality rate. While the exact cause of its sharp rise suddenly and specifically during the second wave still remains debatable, it has been noted that the people who are diabetic and have recovered from COVID-19 infection are more predisposed to mucormycosis. Nevertheless, the precise reason and mechanism(s) underlying the surge of this deadly infection needs to be investigated to comprehend its pathogenesis and pathological elements and discover rationale preventative/ therapeutic solutions. It is speculated that the indiscriminate use of steroids, antibiotics and zinc as a self-medication practice that increased during the COVID-19 epidemic may have promoted the dysbiosis of gut microbiota thereby inducing immune-suppression and making the risk group highly susceptible to this mycotic disease. In these contexts, this timely article attempts to contemplate and discuss some of the possible factors and potential mechanisms that can help to understand and explain the conundrum of sudden, steep and deadly upsurge of mucormycosis infections during the second wave of COVID-19 epidemic.

Dental and Oral Manifestations of COVID-19 Related Mucormycosis: Diagnoses, Management Strategies and Outcomes

“…The major route of infection spread is via inhalation, which then involves lungs and paranasal sinuses [7]. Treating COVID-19 patients with haphazard medication/self-medication of steroids, antibiotics and zinc may have promoted the dysbiosis of gut microbiota which resulted in inducing immunosuppression and rapid emergence to this mycotic disease [8,9]. In the present scenario, the highest risk to fungal mucoromycetes infection is in those patients diagnosed and treated for COVID-19 with broad-spectrum antibiotics, non-invasive ventilation and received corticosteroid therapies.…”

Mucormycosis following COVID19: clinical case and literature review

“…Например, Rhizopus arrhizus является наиболее распространен ным возбудителем мукормикоза в Индии и Франции, а Cunninghamella spp. распространены в Испании [24][25][26]. У наблюдаемой нами больной возбудителем мукор микоза также был Rhizopus arrhizus.…”

Interleukin-37: A Link Between COVID-19, Diabetes, and the Black Fungus

“…Opportunistic fungal infections, such as the black fungus commonly seen in diabetics, hyperglycemia, COVID-19 patients, and linked to corticosteroids have all in common a dysregulated immune response that partly could also be attributed to IL-37 ( Rammaert et al, 2012a ; van Paassen et al, 2020 ; Kumar et al, 2021 ). A significant correlation exists between well-controlled blood glucose and lower serum levels of inflammatory markers such as IL-6, high sensitivity c-reactive protein (CRP), and lactate dehydrogenase in COVID-19 patients ( Gianchandani et al, 2020 ).…”