Alarming rise of mucormycosis after second wave of Covid: Who is at risk?

Abstract

Introduction: Rhino-orbital Cerebral Mucormycosis (ROCM) is a rare invasive fungal infection that generally affects diabetic and immunocompromised individuals. There has been a recent rise in mucormycosis associated with SARS-CoV-2 infection even in non-diabetics. Diabetes, malignancy, transplant, chronic renal insufficiency and iron overload are established risk factors for the infection. This deadly disease demands prompt diagnosis and management to prevent mortality.
Aims and objectives:
1. To study the risk factors predisposing to mucormycosis in previously non-diabetic patients
2. To study the varied presentations and management of mucormycosis in non-diabetic patients
Material and methods: All the patients of mucormycosis who were admitted from May 2021 to December 2023 and who were previously non-diabetic were included in the study. Risk factors causing mucormycosis were studied. Various forms in which mucormycosis presents and their management were studied.
Result: Fifty SARS-CoV-2-positive patients were studied, and male predominance was observed with mean age being 64 years. All the patients had normal fasting and post-prandial blood glucose levels done within the last three months. 30 patients had recently been diagnosed with deranged blood sugar levels. Four patients were HCV positive; two were HBsAg positive, two were active cases of tuberculosis, two had recently diagnosed chronic renal failure, two patients had acute myeloid leukaemia, two had chronic lymphocytic leukaemia and two were known cases of Inflammatory bowel disease. Two patients had hypothyroidism, on thyroxine treatment for the past 4 years. In two patients, ferritin overload and vitamin D deficiency were found. Only 14/50(28%), received dexamethasone during covid-19 treatment. Ten patients out of 50(20%) had a history of oxygen support. All underwent debridement and received systemic liposomal Amphotericin B therapy. Two patients (4%) underwent skin debridement for cutaneous mucormycosis.
Conclusion: We hereby conclude that the recent surge in cases of mucormycosis was due to multiple factors apart from diabetes alone. We recommend restricted use of steroids (only guideline-based in critically ill patients) and strict monitoring for invasive mucormycosis in post-COVID-19 patients. Additionally, other risk factors that predispose the patients to mucormycosis such as Hepatitis, organ transplant, iron overload, hypothyroidism, and tuberculosis should also be kept in mind.