Mucormycosis, The Deadly New Worry to COVID-19 Pandemic.

Kamrul-Hasan, A B; Selim, S

Recently, mucormycosis, extremely rare fungal infections are emerging as a matter of concern in COVID-19. The saprophytic fungi of Mucorales species cause the disease, Mucormycosis, only in immunocompromised hosts. Clinical presentation of mucormycosis is related to the underlying conditions; rhino-cerebral disease is the most common form, especially in patients with diabetes mellitus; pulmonary, cutaneous, or gastrointestinal infections can also occur. Severe COVID-19 itself is a life-threatening disease and various factors, including diabetes, especially when complicated by ketoacidosis, previous respiratory pathology, immunosuppressive therapy, nosocomial infection sources and systemic immune alterations of COVID-19 itself predispose to mucormycosis. No specific biomarkers are available to diagnose mucormycosis; imaging of the involved area and histopathological examination of the biopsied tissue are most important in diagnosis. The underlying medical conditions must be corrected; these include good glycemic control, tapering of steroids, and reducing or stopping immunosuppressive medications. Systemic antifungal therapy with liposomal Amphotericin B is the medical treatment of choice though drug resistance is not uncommon. Surgical debridement of devitalized tissue is often required. Severe COVID-19 patients with secondary co-infections require longer hospitalization and had higher risks of death. The mortality rate is almost 50% despite timely adequate treatment. The judicious use of systemic glucocorticoids and immunosuppressive agents for treating severe disease and hyperglycemia control seems vital for preventing and managing mucormycosis.