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Mucormycosis and COVID-19 an epidemic in a pandemic?
Indrajit Banerjee1, Jared Robinson1, Mohammad Asim2
1Sir Seewoosagur Ramgoolam Medical College, Belle Rive, Mauritius.
Abstract:
Mucormycosis and aspergillosis are rare, invasive and life-threatening infections primarily caused by Rhizopus arrhizus and Aspergillus fumigatus with higher case fatality rates (>50%), respectively. Invasive Aspergillosis and Mucormycosis have been established and recognized as complications of the SARS-CoV-2 infection. Such cases have been intimately linked and related to prior corticosteroid therapy. With the new highly infectious Delta strain (B.1.617.2 and B.1.617.2.1 or AY.1) of the coronavirus which is running rampant throughout India causing unprecedented death tolls, a new crisis is evolving. Invasive "black fungus" (Mucormycosis) is creating an epidemic within a global pandemic. The unique socio-economic, genetic and health status of Indian population culminates into a melting pot which sustains the viable triad for the "black fungus" infection to gain a stronghold. Diabetes mellitus, immunosuppression and the current COVID-19 global pandemic with its massive surges in the country have produced the "perfect storm." Ophthalmologist across India have reported a surge in invasive Mucormycosis cases with a rise in orbital compartment syndrome often calling for radical procedures such as enucleation surgeries. The "black fungus" pandemic and invasive Mucormycosis resulted in the sinister secondary infections and complications are closely linked with the COVID-19 infection in India. It is therefore of the upmost importance that neighbouring countries particularly Nepal and other Asiatic nations take great cognizance of this indolent "black fungus killer" and ensure new screening and testing protocols for early identification to ensure effective management.
Insights
Mucormycosis, a dangerous fungal infection, is surging in India during the COVID-19 pandemic, particularly linked to diabetes and steroid use. Early detection and screening are crucial for neighboring countries to manage this "black fungus" threat.
Area of Science:
- Mycology
- Infectious Diseases
- Public Health
Background:
- Mucormycosis and aspergillosis are rare, invasive, and life-threatening fungal infections.
- These infections, caused by Rhizopus arrhizus and Aspergillus fumigatus respectively, have high fatality rates.
- Invasive Aspergillosis and Mucormycosis are recognized complications of SARS-CoV-2 (COVID-19) infection, often linked to corticosteroid therapy.
Purpose of the Study:
- To highlight the emerging epidemic of invasive Mucormycosis ('black fungus') in India.
- To identify the contributing factors, including the Delta strain of COVID-19, diabetes mellitus, and immunosuppression.
- To emphasize the need for increased awareness and early screening protocols in neighboring countries.
Main Methods:
- Observational analysis of reported cases of invasive fungal infections.
- Correlation of fungal infection surges with COVID-19 pandemic trends and treatment protocols.
- Clinical observations from ophthalmologists regarding orbital complications.
Main Results:
- A significant surge in invasive Mucormycosis cases has been observed in India, coinciding with COVID-19 surges.
- Factors contributing to this 'perfect storm' include widespread diabetes, immunosuppression, and corticosteroid use during COVID-19 treatment.
- Ophthalmologists report an increase in orbital compartment syndrome, necessitating radical surgeries like enucleation.
Conclusions:
- Invasive Mucormycosis is a serious secondary infection complicating COVID-19 in India.
- The confluence of COVID-19, diabetes, and immunosuppression creates a high-risk environment for 'black fungus'.
- Neighboring countries, particularly in Asia, must implement screening and testing protocols for early identification and management of Mucormycosis.
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