Published: 2022-03-24

COVID associated mucormycosis and its etiopathological correlation

Kavita Sachdeva, Amrita Shukla, Mayur V. Kabade, Deepankar Chandrakapure, Stephy Maria Tom, Lakshmy V. Raj


Background: During COVID-19 pandemic, patients with diabetes mellitus (DM) and immunocompromised condition were at risk of opportunistic infections among which mucormycosis came with most dreadful consequences. Mucormycosis is a potential life-threatening, opportunistic fungal infection caused by fungi belonging to the order mucorales. Most vulnerable patients at risks are observed to be patients with uncontrolled blood sugar and diabetic ketoacidosis (DKA), patients with immunocompromised state, severe neutropenia in viral infections, on steroid therapy, oxygen therapy, chemotherapy. Despite aggressive and disfiguring surgeries paired with antifungal therapy, the mortality and morbidity rate are high. The mentioned epidemiological factors were observed and correlation between these were analysed to avoid the predisposing factors in future.

Methods: The study was conducted over 160 patients as prospective cross-sectional design, admitted in mucor ward of NSCB and MCH, Jabalpur. Patients were assessed clinically with related investigations. Consent was taken after explaining the nature and purpose of study.

Results: In our study, mucormycosis was found to affects elderly males more commonly, with immune-compromised state especially in diabetic population, received unsupervised steroid or oxygen therapy in unhygienic setups.

Conclusions: To ensure better outcome, along with early surgical intervention and medical management, environmental predisposing factors must be taken care of. Immunocompromised state especially uncontrolled diabetes and acidosis should be corrected, judicial use of steroids, healthy life style, oxygen supplementation with aseptic masks and tubings, use of distilled water in humidifiers, immunity build-up may bring a major change in prognosis.


Post-COVID mucormycosis, DM, Steroid therapy, Oxygen supplementation, Immunocompromised status

Full Text:



Hibbett DS, Binder M, Bischoff JF, et al. A higher-level phylogenetic classification of the Fungi. Mycol Res. 2007;111:509-47.

Ribes JA, Vanover-Sams CL, Baker DJ. Zygomycetes in human disease. Clin Microbiol Rev. 2000;13:236-301.

Spellberg B, Edwards J Jr, Ibrahim A. Novel perspectives on mucormycosis: pathophysiology, presentation, and management. Clin Microbiol Rev. 2005;18:556-69.

Roden MM, Zaoutis TE, Buchanan WL. Epidemiology and outcome of zygomycosis: a review of 929 reported cases. Clin Infect Dis. 2005;41:634-53.

Sugar AM. Agents of mucormycosis and related species. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and practice of infectious diseases. 6th ed. Philadelphia, PA: Elsevier. 2005;2979.

Ibrahim AS, Edwards JE, Filler SG. Zygomycosis. In: Dismukes WE, Pappas PG, Sobel JD, eds. Clinical mycology. New York, NY: Oxford University Press. 2003;241-51.

Marr KA, Carter RA, Crippa F, Wald A, Corey L. Epidemiology and outcome of mould infections in hematopoietic stem cell transplant recipients. Clin Infect Dis. 2002;34:909-17.

Chinn RY, Diamond RD. Generation of chemotactic factors by Rhizopus oryzae in the presence and absence of serum: relationship to hyphal damage mediated by human neutrophils and effects of hyperglycemia and ketoacidosis. Infect Immun. 1982;38:1123-9.

Lamaris GA, Ben-Ami R, Lewis RE, Chamilos G, Samonis G, Kontoyiannis DP. Increased virulence of Zygomycetes organisms following exposure to voriconazole: a study involving fly and murine models of zygomycosis. J Infect Dis. 2009;199:1399-406.

Chakrabarti A, Sharma SC, Chander J. Epidemiology and pathogenesis of paranasal sinus mycoses. Otolaryngol Head Neck Surg. 1992;107:745-50.

Veress B, Malik OA, Tayeb AA, El Daoud S, El Mahgoub S, El Hassan AM. Further observations on the primary paranasal Aspergillus granuloma in Sudan. Am J Trop Med Hyg. 1973;22:765-72.

Chakrabarti A, Sharma SC. Paranasal sinus mycoses. Indian J Chest Dis Allied Sci. 2000;42:293-304.

Chamilos G, Luna M, Lewis RE, et al. Invasive fungal infections in patients with hematologic malignancies in a tertiary care cancer center: an autopsy study over a 15-year period (1989-2003). Haematologica. 2006;91(7):986-9.

Kontoyiannis DP, Wessel VC, Bodey GP, Rolston VI. Zygomycosis in the 1990s in a tertiary care cancer center. Clin Infect Dis. 2000;30:851-6.

Talmi YP, Goldschmeid-Reouven A, Bakon M. Rhino-orbital and rhino-orbito-cerebral mucormycosis. Otolaryngol Head Neck Surg. 2002;127:22-31.

Funada H, Matsuda T. Pulmonary mucormycosis in a hematology ward. Intern Med. 1996;35:540-4.

Prabhu RM, Patel R. Mucormycosis and entomophthoramycosis: a review of the clinical manifestations, diagnosis and treatment. Clin Microbiol Infect. 2004;10(1):31-47.

Fogarty C, Regennitter F, Viozzi CF. Invasive fungal infection of the maxilla following dental extractions in a patient with chronic obstructive pulmonary disease. J Can Dent Assoc. 2006;72(2):149-52.

Tugsel Z, Sezer B, Akalin T. Facial swelling and palatal ulceration in a diabetic patient. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004;98:630-6.

Kwon-Chung KJ, Bennett JE. Mucormycosis. In: Medical mycology. Philadelphia, PA: Lea and Febiger. 1992;524-59.

Gartenberg G, Bottone EJ, Keusch GT, Weitzman I. Hospital-acquired mucormycosis (Rhizopus rhizopodiformis) of skin and subcutaneous tissue: epidemiology, mycology and treatment. New Engl J Med. 1978;299:1115-8.