An Invasive fungal infection is adding to Covid-19 healthcare concerns: It is called Mucormycosis


COVID-19 is an infectious condition caused by the virus SARS-CoV-2, which mainly affects the human respiratory tract (lungs, nose, sinuses). While COVID-19 can range from mild to serious, for people with co-morbidities (cardiovascular disease, diabetes,
respiratory conditions) the condition can often be particularly harmful requiring hospitalization. A majority of COVID 19 related
deaths are reported among people with co-morbidities. In many instances, patients who have recovered from COVID-19 have
returned to hospitals with a series of complications unrelated to the respiratory system, indicating that the virus has the potential to
attack multiple organs in the body. One such serious complication that has emerged as an association with COVID-19 in recent
months has been mucormycosis, an invasive fungal infection with a potential to cause serious consequences including death.

Mucormycosis is caused by mucormycetes, a group of fungi that usually attack immuno-compromised individuals. It is a rare fungal
infection but in recent months hospitals across the country have reported a spurt in cases, mostly in patients who have recovered
from COVID-19. Many such episodes of this fungal infection have also resulted in deaths, compounding the COVID-19 concerns for
healthcare practitioners.

Being an invasive fungal infection, mucormycosis can eat up the sinuses, jawbone and even cause loss of vision among sufferers, if
not treated effectively in time. It may also affect the brain, lungs and is believed to result in a mortality rate of up to 50%. Therefore,
it is extremely important to educate people about this infection and spread awareness about the same. Early identification and
intervention can prevent the disease from spreading in the body and reduce fatality.

What exactly is Mucormycosis and whom does it infect? 

As mentioned above, mucormycosis primarily invades individuals with weakened immune systems. For example, people living with
health conditions such as uncontrolled diabetes, AIDS or blood cancers are characterised by weak immunity that makes them
susceptible to infectious diseases. The use of corticosteroid treatment and anti-cytokine directed strategies in patients along with
high fungal spore counts in the environment increases the chances of mould infection.

Hyperglycemia (high blood sugar levels), which is not controlled, is an important risk factor that predisposes such people to
mucormycosis. People experiencing diabetic ketoacidosis, a serious complication of diabetes, are the most at risk. Coupled with the
potential implications of steroid-induced hyperglycemia, COVID-19 patients with uncontrolled diabetes, who are also receiving
corticosteroids or other immunosuppressants, seem to be highly vulnerable to the development of mucormycosis.

Similarly, patients with certain types of cancers, long-term use of corticosteroid for other conditions and those having undergone
organ transplantation or AIDS are also highly susceptible to this fungal infection, as these conditions lower the body’s immunity
against external infections and germs. Treatment of severe cases of COVID-19 often involves the use of corticosteroids and other
immunosuppressant drugs to prevent a potentially life-threatening cytokine storm associated inflammatory state. The treatment
may temporarily weaken the immune response of patients, thereby increasing susceptibility to mucormycosis.

How does Mucormycosis manifest itself?

After an immuno compromised individual is exposed to fungal spores in the air and inhales them, mucormycosis starts affecting the
sinuses or the lungs. It can also affect the wound after a cut, burn, or other types of skin injury. It also tends to spread to the eyes
and the brain. If appropriate medical intervention is not initiated in time, the infection can spread rapidly and may result in multiple
organ failures. Therefore, immunocompromised patients must be aware of its symptoms and raise a red flag immediately.

The initial symptoms of mucormycosis include continuous headache, nasal congestion, fever, choked throat, heaviness around the facial area and swelling. Also, other symptoms of mucormycosis that can make it immediately recognisable include black spots in
nasal cavities or mouth or other swollen areas.

For COVID-19 recovered patients or those with other immune-compromising conditions, it is important to stay alert to any of the
above symptoms and report them immediately to a doctor. Furthermore, it is important to know that the condition of
mucormycosis is not contagious.

Can it be treated?

The disease, though potentially deadly, can be treated effectively if a timely diagnosis is made followed by an immediate
intervention. Mucormycosis treatment involves a combination of surgical removal of affected tissues and the use of aggressive anti-
fungal therapy, usually intravenous liposomal amphotericin B (LAmB), depending upon the patient’s condition and progression of
the disease. Several recently published reports and studies have underlined successful clinical recovery of patients with injections of
Liposomal Amphotericin B.

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Disclaimer

Views expressed above are the author’s own.



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