Mucormycosis in COVID-19 patients with uncontrolled diabetes – the lethal triangle

Abstract

BACKGROUND. Coronavirus disease 2019 (COVID-19) is one of the main global health problems of the twenty-first century, with more than one-hundred million people infected and more than two million deaths. The immunosuppression caused by SARS-CoV-2 infection along with steroidal treatment, hyperglycaemia and elevated ferritin levels creates the perfect environment for opportunistic infections such as mucormycosis. COVID-19-associated mucormycosis carries a high mortality rate. Therefore, in addition to antifungal therapy and aggressive surgical debridement of necrotic tissue, strategies to improve glycaemic index is the key factor in order to obtain a favourable outcome. MATERIAL AND METHODS. For the purpose of this article, the PubMed databases were searched using MeSH descriptors and the Boolean operator “AND” for the terms “rhinosinusal” and “mucormycosis” and “diabetes”, between February 2019 – December 2021. Clinical characteristics, therapy and outcome data were gathered and compared to what has previously been reported in the literature. Also, we report the case of a 68-year-old patient with uncontrolled type 2 diabetes mellitus, who developed mucormycosis during post-COVID period, to underline the need of early detection of this potentially deadly fungal illness. RESULTS. The clinical and imaging evaluation revealed no evidence of disease recurrence, at one- and two-months’ follow-ups. CONCLUSION. In this context, we would like to emphasize the importance of a high index of suspicion for mucormycosis in patients with COVID-19 infection, with pre-existing medical disorders, presenting with rhino-orbital or rhino-cerebral symptomatology.

Mucormicose Em Paciente Com Cetoacidose Diabética Pós-Covid-19 Na Região Noroeste Do Estado Do Rio De Janeiro

“…Ao exame físico, pupilas midriáticas e sem fotorreação, apneia, pulsos periféricos e centrais e reflexo córneo-palpebral ausentes. Neagu et al (2022) afirmam que a conjunção da COVID-19, diabetes não controlada e a infecção por fungos causadores de mucormicose compõem um "triângulo letal" em virtude da dificuldade de controle terapêutico e das altas taxas de mortalidade decorrentes da associação dessas patologias.…”