Black fungus immunosuppressive epidemic with Covid-19 associated mucormycosis (zygomycosis): a clinical and diagnostic perspective from India

Abstract

The catastrophic phase of Covid-19 turns the table over with the spread of its disastrous transmission network throughout the world. Covid-19 associated with mucormycosis fungal infection accompanied by opportunistic comorbidities have emerged the myriad of complications and manifestations. We searched the electronic databases of Google Scholar, PubMed, Springer, and Elsevier until June 05, 2021, using keywords. We retrieved the details of confirmed and suspected mucormycosis patients associated with Covid-19. We analyzed the case reports, treatment given for Covid-19, steroids used, associated comorbidities, mucormycosis site involved, and patients survived or dead. Overall, 102 patients of mucormycosis associated with Covid-19 have been reported from India. Mucormycosis was predominant in males (69.6%) rather than females (19.6%), and most of the patients were active Covid-19 cases (70.5%). Steroids were mostly used (68.6%) for the treatment of Covid-19 followed by remdesivir (10.7%). Patients were suffering from diabetes mellitus (88.2%) and severe diabetic ketoacidosis (11.7%). Mucormycosis affects the sino-nasal (72.5%), orbit (24.5%), central nervous system (18.6%), and maxillary necrosis (13.7%) of the patients. The Mortality rate was recorded as 23.5%, and recovery rate was 2.9%. Diabetes mellitus cases are highest in India as compared to other countries, and prevalent use of steroids with the background of Covid-19 becomes an opportunistic environment for mucormycosis fungal infection to survive.

Global emergence of resistance to fluconazole and voriconazole in Candida parapsilosis in tertiary hospitals in Spain during the COVID-19 pandemic

“…This correlation suggests that C. parapsilosis clones might have colonized the hospital surfaces, which increases the risk of recirculating among patients along the time and, in parallel, increases the risk of invasive infections among the most fragile ones. Previous studies, in fact, have shown, not only an increase incidence of C. parapsilosis infections in COVID-19 patients [34], but also other fungal diseases, such as Covid Associated Pulmonary Aspergillosis (CAPA) [35][36][37], mucormycosis [38][39][40] and Candida infections [41,42] (see reviews in [43,44]).…”

Current clinical status of new COVID-19 vaccines and immunotherapy

“…This could be due to the airborne spores of fungi that enter the body through inhalation or through open wounds. Healthy people generally clear these spores from their bodies, but immunocompromised individuals or patients associated with comorbidities are the prime targets for nosocomial infections (Singh et al 2022 ). Some studies also mention that (Quinn and Bell 2022 ) people who have recovered from the infection are likely to have negative impacts on their quality of life, reduction in functional abilities, and a shortened life expectancy.…”

Effect of Indoor Bioaerosols (Fungal) Exposure on the Health of Post-COVID-19 Patients and Possible Mitigation Strategies

“…The death rate reported was 23.5%, and the rate of recovery was reported to be 2.9%. Patients suffering from diabetes mellitus are more common in India than in other nations, and the widespread consumption of steroids along with the presence of COVID-19 creates a suitable environment for mucormycosis fungus infection to thrive [35].…”