Severe COVID-19 disease is associated with an increase in pro-inflammatory markers, such as IL-1, IL-6, and tumor necrosis alpha, less CD4 interferon-gamma expression, and fewer CD4 and CD8 cells, which increase the susceptibility to bacterial and fungal infections. One such opportunistic fungal infection is mucormycosis. Initially, it was debated whether a person taking immunosuppressants, such as corticosteroids, and monoclonal antibodies will be at higher risk for COVID-19 or whether the immunosuppresive state would cause a more severe COVID-19 disease. However, immunosuppressants are currently continued unless the patients are at greater risk of severe COVID-19 infection or are on high-dose corticosteroids therapy. As understood so far, COVID-19 infection may induce significant and persistent lymphopenia, which in turn increases the risk of opportunistic infections. It is also noted that 85% of the COVID-19 patients’ laboratory findings showed lymphopenia. This means that patients with severe COVID-19 have markedly lower absolute number of T lymphocytes, CD4+T and CD8+ T cells and, since the lymphocytes play a major role in maintaining the immune homeostasis, the patients with COVID-19 are highly susceptible to fungal co-infections. This report is intended to raise awareness of the importance of early detection and treatment of mucormycosis and other fungal diseases, such as candidiasis, SARS-CoV-2-associated pulmonary aspergillosis, pneumocystis pneumonia and cryptococcal disease, in COVID-19 patients, to reduce the risk of mortality.

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Among 1254 patients with coronary artery occlusive disease (CAOD) who underwent cardiac catheterization studies in our laboratory from 1975 through 1977,114 (9%) had signWicant (250%) stenosis of the left main coronary artery (LMCA). Thirty-four of the 114 (29.8%) had stenosis of the LMCA ostium (2.7% of all CAOD patients). Clinical, hemodynamlc, and anglographic data of the 34 patients wereanalyzed. Unstable angina was more frequent in these patients, most of whom were in functional classes 111 and IV, than those with other LMCA lesions. Of the 18 who underwent treadmill exercise testing, results were positive In 16 (11 of whom had ST segment depression 3 2 mm Hg), negative in none and indeterminate in two. By avoiding overlapping the coronary ostium with the sinus of Valsalva without significant foreshortening of the LMCA during angiography, LMCA ostial stenosis was recognizable in all patients in the moderate left anterior oblique position only and not in other projections. Coronary arteriography was performed without occurrence of ventricular fibrillation, infarction, or any other morbidity or mortality in the 34, as well as in the entire group of 114 patients with LMCA disease. To ensure a safe procedure, left ventricular filling pressure was monitored constantly via a catheter in the pulmonary artery, and patients experiencing sharp Increases following coronary injections were promptly treated with nitroglycerine.Coronary artery bypass, with an average of 3.2 grafts per patient, was performed in 30 patients with a survival of 97% and only one death In a patient who underwent aortic valve replacement and triple bypass. Stenosis of the ostium of the LMCA is not an uncommon lesion in patients with CAOD and should be suspected in all patients whose symptoms are severe. Coronary angiography, performed with adequate precautions, as well as aortocoronary bypass, can be accomplished successfully.