Published: 2021-04-23

A case series of invasive mucormycosis in patients with COVID-19 infection

Neha Mishra, Venkata Sai Shashank Mutya, Alphonsa Thomas, Girish Rai, Bathi Reddy, Anithakumari Alnipully Mohanan, Shalina Ray, Anand Vellore Thiruvengadem, Vishwanath Siddini, Raghuraj Hegde


Rhino-orbital-cerebral mucormycosis is an invasive disease associated with high mortality ranging from 25-62%. There is an increase in the incidence of mucormycosis in post COVID-19 infection patients. We have come across 10 such patients. On retrospective analysis of the patient’s records, we found that 60% patients had received steroids and majority had co-morbidities. All the patients received similar treatment with IV amphotericin B and local debridement and the mortality rate was as high as 44%. We conclude that patients with COVID 19 infection are susceptible to mucormycosis because of impairment of barrier defense, dysfunction phagocytes and lymphocytes and the use of immunosuppressive medications such as steroids and tocilizumab.


COVID-19, Invasive mucomycosis, Amphotericin B, Steroids

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Ribes JC, Vanover-Sans CL. Zygomycetes in human disease. Clin Microbiol Rev. 2000;13(2):236-301.

Waldorf AR. Pulmonary defense mechanisms against opportunistic fungal pathogens. Immunol Ser. 1989;47:243-71.

Waldorf AR, Ruderman N, Diamond RD. Specific susceptibity to mucormycosis in murine diabetes and bronchoalveolar macrophage defense mechanisms against Rhizopus. J Clin Invest. 1984;74(1):150-60.

Bouchara JP, Oumeziane NA, Lissitzky JC, Larcher G, Tronchin G, Chabasse D. Attachment of spores of the human pathogenic fungus Rhizopus oryzae to extracellular matrix components. Eur J Cell Biol. 1996;70(1):76-83.

Wiersinga WJ, Rhodes A, Cheng AC, Peacock SJ, Prescott HC. Pathophysiology, transmission, diagnosis, and treatment of coronavirus disease 2019 (COVID-19): a review. JAMA. 2020;324(4):782-93.

Peter WH, Martin JL. Dexamethasone in hospitalised patients with COVID-19: preliminary report. N Eng J Med. 2020.

Song G, Liang G, Liu W. Fungal co-infections associated with global COVID-19 pandemic: a clinical and diagnostic perspective from China. Mycopathologia. 2020;185:599-26.

Mehta S, Pandey A. Rhino-orbital mucormycosis associated with COVID-19. Cureus. 2000;12(9):10726.

Werthman-Ehrenreich A. Mucormycosis with orbital compartment Syndrome in a patient with COVID-19. Am J Emerg Med. 2021;264:64-8.

Chowdhary A, Tarai B, Singh A, Sharma A. Multidrug-resistant Candida auris infections in critically ill coronavirus disease patients, India, April-July 2020. Emerg Infect Dis. 2020;26(11):2694-6.