An Epidemic of Mucormycosis Coinciding With the COVID-19 Pandemic in India

Abstract

Dear Editor,An epidemic outbreak of mucormycosis, a rare, lifethreatening angio-invasive mycotic disease, is occurring at the same time as the second wave of the COVID-19 pandemic in India. As of June 2021, India has reported 40,845 cases and 3129 deaths due to this fatal fungal disease. 1 The management of the COVID-19 and mucormycosis syndemic in India may provide valuable lessons for coping with future public health emergencies.The World Health Organization Global Antimicrobial Resistance Surveillance System (GLASS) diagnostic stewardship practice (DSP) guidelines are the basis for treatment. 2 However, the use of invasive bronchoalveolar lavage or biopsy sampling, which is not feasible in critically ill mucormycosis patients and the lack of molecular diagnostic tools, prevented the full implementation of DSP. It is important to develop appropriate sampling and diagnostic techniques.Antifungal therapy and surgical debridement, including functional endoscopic sinus surgery, orbital exenteration, or craniotomy, depending on the fungal invasiveness, are the main approach in aggressive mucormycosis management. There is no standard risk-stratified treatment protocol for the use of steroids and/or immunosuppressants and further research is required to standardize treatment protocols.Patients diagnosed with mucormycosis are often reluctant to undergo disfiguring surgical debridement and possibly experience visual impairment. Hence, the availability of mental health specialists in counseling is necessary during the rehabilitation of mucormycosis patients. There is a correlation between suicidal ideation and/or attempts and visual impairment among older adults from low-and middle-income countries. 3 The effective utilization of telehealth technology will provide increased healthcare access to mucormycosis and other infectious disease consultations, early diagnosis, and surveillance in community health centers or nursing homes. Perhaps in the future, humanoid robots will be used for patient care in large hospitals to reduce infection transmission.The establishment of dedicated multispecialty mucormycosis hospitals could provide early, comprehensive care and a rational allocation of resources at the time of outbreaks. This idea is based on the approach of Rajasthan (an Indian state) to reduce the increase in mucormycosis cases. 4 Fungal diseases cause 1.5 million deaths annually and increased research funding is needed for diagnostics and therapeutics for mucormycosis and other fungal infections. 5 Further outbreaks of COVID-19 are likely to occur and this may be accompanied by associated mucormycosis in India. Government and other healthcare experts need to work in synchrony to provide comprehensive physical and mental health management.

Endoplasmic reticulum stress and therapeutic strategies in metabolic, neurodegenerative diseases and cancer

“…Activated ATF6 translocates to the nucleus, binds to ERSE-associated genes, and instigates their transcriptional activation (Adachi et al 2008 ). The downstream target genes of ATF6 exhibit partial overlap with those induced by IRE1 and PERK, encompassing genes that facilitate protein folding, translocation, and synthesis (Adachi et al 2008 ; MohanaSundaram et al 2022 ). Additionally, ATF6 has the capability to form dimers with XBP1, activating ERAD-related genes.…”