Current Treatment Options for COVID-19 Associated Mucormycosis: Present Status and Future Perspectives

Abstract

Mucormycosis has become increasingly associated with COVID-19, leading to the use of the term “COVID-19 associated mucormycosis (CAM)”. Treatment of CAM is challenging due to factors such as resistance to many antifungals and underlying co-morbidities. India is particularly at risk for this disease due to the large number of patients with COVID-19 carrying comorbidities that predispose them to the development of mucormycosis. Additionally, mucormycosis treatment is complicated due to the atypical symptoms and delayed presentation after the resolution of COVID-19. Since this disease is associated with increased morbidity and mortality, early identification and diagnosis are desirable to initiate a suitable combination of therapies and control the disease. At present, the first-line treatment involves Amphotericin B and surgical debridement. To overcome limitations associated with surgery (invasive, multiple procedures required) and amphotericin B (toxicity, extended duration and limited clinical success), additional therapies can be utilized as adjuncts or alternatives to reduce treatment duration and improve prognosis. This review discusses the challenges associated with treating CAM and the critical aspects for controlling this invasive fungal infection—early diagnosis and initiation of therapy, reversal of risk factors, and adoption of a multipronged treatment strategy. It also details the various therapeutic options (in vitro, in vivo and human case reports) that have been used for the treatment of CAM.

Post-COVID-19 Invasive Fungal Sinusitis: A Case Series from Southern India

“…20 For refractory/intolerant cases for longterm maintenance, posaconazole/other azoles should be used as an alternative treatment option. 21,22 Our case series highlights the association of fungal sinusitis occurrence with post-COVID-19 in patients.…”

Degree of Orbital Affections in Cases of Nasal Mucormycosis Associated with COVID-19

“…The ocular examination includes a fundus examination, testing for extraocular abnormalities, extraocular motility, and visual acuity. Patients with mucormycosis frequently have abnormalities such ophthalmoplegia, proptosis, blepharoptosis, impaired vision up to no light perception, oedema, and necrosis (25) .…”

Tracheal and Endobronchial Mucorales in a Young Liver Transplanted Patient: A Rare Condition

“…Immunohistochemistry is another possible tool, by using monoclonal antibodies, but must be performed by trained personnel and specialized laboratories [11]. The keys to a successful treatment involve three main aspects: consideration of risk factors and co-morbidities, early and aggressive surgical debridement of infected tissue if possible, and administration of antifungal therapy to control the spread of infection [12]. In this case, we treated the patient with double antifungal intravenous therapy (amphotericin B and isavuconazole), with the adjunction of amphotericin B aerosols.…”