DOI: http://dx.doi.org/10.18203/issn.2454-5929.ijohns20220488

The mucormycosis surge in COVID-19 pandemic: an analysis of associated risk factors and review of literature of reported cases

Chandrashekhar Mahato, Navneet Magon, Shail Prasad, Amit Kumar Tyagi

Abstract


COVID-19 patients are particularly susceptible to secondary infections, both bacterial and fungal, most likely due to immunological dysregulation. Secondary systemic mucormycosis was identified to be the significant cause of this epidemic among fungal infections. Post-COVID-19 complications are being reported all around the world, creating major pressure on healthcare services and the lives of the patients. PRISMA guidelines were used to conduct a literature review for articles published on COVID-19 associated Mucormycosis (CAM) between January 1, 2020, to May 18, 2021. The inclusion criteria were based on peer-reviewed studies in English covering cases with COVID-associated mucormycosis (CAM). Articles describing fungal coinfections that were not mucormycosis cases, non-COVID-19 cases, and studies with a lack of clarity were excluded from the review. The review includes 31 articles comprising of 21 Case Reports and 10 Case Series. Out of 104 cases, 76% were from India, 77.9% were males. Predisposing variables such as diabetes (71.15%), hypertension (37.5%), and ketoacidosis (10.6%) were found to be substantial contributors to the aggressive growth of opportunistic fungal infections such as mucormycosis. Rhino-orbital mucormycosis (n=47), followed by Rhino-orbital-cerebral mucormycosis (n=32), and Pulmonary mucormycosis (n=10) were commonly reported in the case studies and literature reviews which presented either following COVID-19 infection or a few weeks after active COVID-19 infection. Significant mortality (36.9%) was reported among patients. As per our observations, CAM could be a serious consequence of severe COVID-19, especially in people with uncontrolled diabetes.

 


Keywords


COVID-19, Mucormycosis, Diabetes mellitus, CAM, SARS Co-V2

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References


Mehta S, Pandey A. Rhino-Orbital Mucormycosis Associated With COVID-19. Cureus. 2020;12(9).

Ismaiel WF, H. MA, Eldsoky I, Ibrahim AA. The impact of COVID-19 outbreak on the incidence of acute invasive fungal rhinosinusitis. Am J Otolaryngol. Published online 2021.

Petrikkos G, Tsioutis C. Recent Advances in the Pathogenesis of Mucormycoses. Clin Ther. 2018;40(6):894-902.

Omara F 0, Blakley BR. The effects of iron deficiency and iron overload on cell-mediated immunity in the mouse. Br J o j Nutr. 2021;72:899-909.

Prakash H, Chakrabarti A. Epidemiology of Mucormycosis in India. Published online 2021:1-12.

Patel A, Kaur H, Xess I. A multicentre observational study on the epidemiology, risk factors, management and outcomes of mucormycosis in India. Clin Microbiol Infect. 2020;26(7):944.e9-944.e15.

Sharma S, Grover M, Bhargava S, Samdani S, Kataria T. Post coronavirus disease mucormycosis: a deadly addition to the pandemic spectrum. J Laryngol Otol. 2021;1-6.

Moorthy A, Gaikwad R, Krishna S. SARS-CoV-2, Uncontrolled Diabetes and Corticosteroids—An Unholy Trinity in Invasive Fungal Infections of the Maxillofacial Region? A Retrospective, Multi-centric Analysis. J Maxillofac Oral Surg. 2021;2.

Page MJ, Mckenzie JE, Bossuyt PM. RESEARCH METHODS AND REPORTING The PRISMA 2020 statement : an updated guideline for reporting systematic reviews Systematic reviews and Meta-Analyses. Published online 2021.

Sebastian SK, Kumar VB, Gupta M, Sharma Y. Covid Assossiated Invasive Fungal Sinusitis. Indian J Otolaryngol Head Neck Surg. Published online 2021.

John TM, Jacob CN, Kontoyiannis DP. When uncontrolled diabetes mellitus and severe covid-19 converge: The perfect storm for mucormycosis. J Fungi. 2021;7(4).

Waizel-Haiat S, Guerrero-Paz JA, Sanchez-Hurtado L, Romero-Gutierrez L. A Case of Fatal Rhino-Orbital Mucormycosis Associated With New Onset Diabetic Ketoacidosis and COVID-19. Cureus. 2021;13(2021).

Junior ES de M, Santos MEL dos, Baba R. Rare and Fatal Gastrointestional Mucormycosis (Zygomycosis) in a COVID-19 Patient: A Case Report. Clin Endosc. 2020.

Singh AK, Singh R. Mucormycosis in COVID-19: A systematic review of cases reported worldwide and in India. Diabetes Metab Syndr Clin Res Rev. Published online 2021;1-7.

Prakash H, Chakrabarti A. Global epidemiology of mucormycosis. J Fungi. 2019;5(1).

Baldin C, Ibrahim AS. Molecular mechanisms of mucormycosis—The bitter and the sweet. PLoS Pathog. 2017;13(8):1-9.

Sen M, Lahane S, Lahane TP. Mucor in a Viral Land: A tale of two pathogens. Indian J Ophthalmol. 2021;69(2).

Spellberg B, Jr. JE, Ibrahim A. Novel Perspectives on Mucormycosis: Pathophysiology, Presentation, and Management. Published online 2005:556-69.

Raghavendra MV., Kumar Chennamchetty V, Adimulapu S, Patel Kola B, De Padua M, C A. Post-COVID pulmonary mucormycosis- A case report. IP Indian J Immunol Respir Med. 2021;6(1):62-66.

Dronamraju S, Agrawal S, Kumar S. Angioinvasion of Anterior Cerebral Artery by Rhinocerebral Mucormycosis Leading to Intraparenchymal Hemorrhage: A Rare Case Report. Medical Science. 2021;25(111):1088-91.

Garg D, Muthu V, Sehgal IS, Bhalla A, Agarwal R. Coronavirus Disease (COVID-19) Associated Mucormycosis (CAM): Case Report and Systematic Review of Literature. Mycopathologia. 2021.

Honavar SG, Sen M, Lahane S, Lahane TP, Parekh R. Original Article Mucor in a Viral Land : A Tale of Two Pathogens. Indian J Ophthalmol. 2021;(2).

Maini A, Tomar G, Khanna D, Kini Y, Mehta H, Bhagyasree V. Sino-orbital mucormycosis in a COVID-19 patient: A case report. Int J Surg Case Rep. 2021;82:105957.

Mishra N, Mutya VSS, Thomas A. A case series of invasive mucormycosis in patients with COVID-19 infection. Int J Otorhinolaryngol Head Neck Surg. 2021;7(5):867.

Revannavar SM, P S S, Samaga L, V K V. COVID-19 triggering mucormycosis in a susceptible patient: a new phenomenon in the developing world? BMJ Case Rep. 2021;14(4).

Saldanha M, Reddy R, Vincent MJ. Title of the Article: Paranasal Mucormycosis in COVID-19 Patient. Indian J Otolaryngol Head Neck Surg. 2021;1-4.

Sarkar S, Gokhale T, Choudhury SS, Deb AK. COVID-19 and Orbital Mucormycosis. Indian Journal of Ophthalmology. 2021;69:1002-4.

Shirke PD, Chitguppi R. Post-Covid Jaw Osteomyelitis : A Case Series. 2021.

Pauli MA, Pereira L de M, Monteiro ML, de Camargo AR, Rabelo GD. Painful palatal lesion in a patient with COVID-19. Oral Surg Oral Med Oral Pathol Oral Radiol. 2021;00(00):1-6.

Karimi-Galougahi M, Arastou S, Haseli S. Fulminant mucormycosis complicating coronavirus disease 2019 (COVID-19). Int Forum Allergy Rhinol. 2021;(February):2-3.

Ahmadikia K, Hashemi SJ, Khodavaisy S. The double-edged sword of systemic corticosteroid therapy in viral pneumonia: A case report and comparative review of influenza-associated mucormycosis versus COVID-19 associated mucormycosis. Mycoses. 2021;:1-11.

Veisi A, Bagheri A, Eshaghi M, Rikhtehgar MH, Rezaei Kanavi M, Farjad R. Rhino-orbital mucormycosis during steroid therapy in COVID-19 patients: A case report. Eur J Ophthalmol. Published online 2021;112067212110094.

Pasero D, Sanna S, Terragni P. A Challenging Complication Following SARS-CoV-2 Infection_ a Case of Pulmonary Mucormycosis.2020.

Alekseyev K, Didenko L, Chaudhry B. Rhinocerebral Mucormycosis and COVID-19 Pneumonia. 2021;12(3)

Kanwar A, Jordan A, Cortes M, Jackson BR. A Fatal Case of Rhizopus azygosporus Pneumonia Following COVID-19. J Fungi. 2021;7(174).

Pandian E, Kang J, Cockerham K. The Role of Retrobulbar Liposomal Amphotericin in Orbital Apex Syndrome in a COVID – 19 Positive Diabetic. Journal of Medical Clinical Case Reports. 2021;3:19-21.

Dallalzadeh LO, Ozzello DJ, Liu CY, Kikkawa DO, Korn BS. Secondary infection with rhino-orbital cerebral mucormycosis associated with COVID-19. Orbit (London). 2021.

Johnson AK, Ghazarian Z, Cendrowski KD, Persichino JG. Pulmonary aspergillosis and mucormycosis in a patient with COVID-19. Med Mycol Case Rep. 2021;32:64-7.

Khan N, Gutierrez CG, Martinez DV, Proud KC. A case report of COVID-19 associated pulmonary mucormycosis. Arch Clin Cases. 2020;07(03):46-51.

Khatri A, Chang K-M, Berlinrut I, Wallach F. Mucormycosis after Coronavirus disease 2019 infection in a heart transplant recipient – Case report and review of literature. J Med Mycol. 2021;31(2):101125.

Mekonnen ZK, Ashraf DC, Simko JP, Winn BJ. Acute Invasive Rhino-Orbital Mucormycosis in a Patient With COVID-19-Associated Acute Respiratory Distress Syndrome. 2021;37:2(2021).

Placik DA, Taylor WL, Wnuk NM. Bronchopleural fistula development in the setting of novel therapies for acute respiratory distress syndrome in SARS-CoV-2 pneumonia. Radiol Case Reports. 2020;15(11):2378-81.

Werthman-Ehrenreich A. Mucormycosis with orbital compartment syndrome in a patient with COVID-19. Am J Emerg Med. 2021;42:264.e5-e8.