Mucormycosis Amid COVID-19 Crisis: Pathogenesis, Diagnosis, and Novel Treatment Strategies to Combat the Spread

Abstract

The havoc unleashed by COVID-19 pandemic has paved way for secondary ominous fungal infections like Mucormycosis. It is caused by a class of opportunistic pathogens from the order Mucorales. Fatality rates due to this contagious infection are extremely high. Numerous clinical manifestations result in damage to multiple organs subject to the patient’s underlying condition. Lack of a proper detection method and reliable treatment has made the management of this infection troublesome. Several reports studying the behavior pattern of Mucorales inside the host by modulation of its defense mechanisms have helped in understanding the pathogenesis of this angio-invasive infection. Many recent advances in diagnosis and treatment of this fungal infection have not been much beneficial. Therefore, there is a need to foster more viable strategies. This article summarizes current and imminent approaches that could aid effective management of these secondary infections in these times of global pandemic. It is foreseen that the development of newer antifungal drugs, antimicrobial peptides, and nanotechnology-based approaches for drug delivery would help combat this infection and curb its spread.

Mucormycosis an added burden to Covid-19 Patients: An in-depth systematic review

“…An interesting fact to note here is that among various risk factors AIDS, liver cirrhosis, cancer, hematological diseases, high doses of steroids or solid organ transplant make patients vulnerable to mucormycosis. Decreased monocyte and neutrophil counts may be critical ones as they are potentially known to limit the spore germination [66] . Recent outbreak in India may be due to the high doses of steroids and uncontrolled blood sugar level in COVID-19 patients.…”

“…In present times we are lacking clinically proven and standardized test as the use of molecular techniques on both fresh clinical material and histopathological sections for the diagnosis of mucormycosis are presently minimally supported because formalin destroys DNA; thus, samples which are collected from patients and are not preserved in paraffin preferred over paraffin-embedded tissue [123] . DNA finding in serum is extremely encouraging, but it is only supported with modest strength due to a lack of standardisation.…”

“…Internal transcribed spacer (ITS) sequencing is widely proposed as the effective approach for molecular identification. MALDI-TOF (matrix aided laser desorption ionisation-time of flight) identification supported to some extend since it mostly relies on in-house databases, which many diagnostic canters lack [123] .…”

“…In 2017 European Conference on Infections in Leukemia (ECIL) is supposed to be the pioneer conference that stated treatment guidelines for mucormycosis, which were subsequently updated by European Confederation of Medical Mycology (EMM) for treatment of CAM, with former recommended liposomal Amphotericin B and later recommended Amphotericin B lipid complex for treatment of CAM [123] , [128] . Mucormycosis is a severe infection that requires the use of antifungal medications prescribed by a doctor.…”

In Silico Evaluation of Antifungal Compounds from Marine Sponges against COVID-19-Associated Mucormycosis

“…Over 47,000 cases were reported in India by July 2021. Out of which, approximately 28,000 were active cases [ 10 , 11 ]. For the period of August 2021 to February 2022, the exact number of COVID-19-associated mucormycosis cases in India remains uncertain.…”