Title : COVID-19 & mucormycosis
Abstract:
The outbreak of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory system coronavirus 2 (SARS-CoV-2) was first reported in Wuhan, China and has been sweeping across the globe. It has been associated with a wide range of opportunistic bacterial and fungal infections. COVID-19 likely increases the risk for fungal infections because of its effect on the immune system and because treatments for COVID-19 (like steroids and other drugs) can weaken the body’s defenses against fungi. COVID-19-associated fungal infections can lead to severe illness and death. The most commonly reported fungal infections in patients with COVID-19 include aspergillosis, invasive candidiasis, and mucormycosis. COVID-19-associated mucormycosis became a major public health problem particularly in India. It is postulated that COVID-19 associated mucormycosis (CAM) is driven by complex host-microbe interactions.
Mucormycosis, erroneously referred to as “black fungus”, is a rapidly progressive and potentially lethal, angioinvasive fungal infection caused by Mucorales species. The ubiquitous mold usually gains entry into the host through the respiratory tract. Alternatively, organisms may enter the body through cuts or burns in the skin or may become disseminated via bloodstream infection. COVID-19 associated mucormycosis may affect the lungs (pulmonary mucormycosis) but nose and sinuses are the most frequent infection sites causing symptoms such as nasal blockage and discharge, unilateral facial swelling, pain and/or redness around eyes or nose and black necrotic lesions. It can then spread to the eyes, causing blindness, or to the brain, causing headaches and seizures (rhino-orbito-cerebral mucormycosis). Diagnosis is usually made by clinical findings supported by diagnostic nasal endoscopy or contrast-enhanced MRI or CT scan coupled with microbiological confirmation on direct microscopy, culture or histopathology. Suspected mucormycosis requires urgent intervention as delayed initiation of therapy is associated with increased mortality. The global guidelines of European Confederation of Medical Mycology (ECMM) and the Mycoses Study Group Education and Research Consortium (MSG ERC) strongly support an early complete surgical treatment for mucormycosis whenever possible, in addition to systemic antifungal treatment. Liposomal Amphotericin B, Amphotericin B lipid complex, and posaconazole oral suspension are treated as the first-line antifungal monotherapy, while isavuconazole is strongly supported as salvage treatment. Prognosis remains poor even with aggressive therapy with reported mortality rates of 33.3-80 per cent. Hence, it becomes extremely important in COVID-19 setting to optimize the indications for systemic steroids, ensure judicious use of tocilizumab, monitor blood glucose levels & minimize the patient exposure to potential sources of infection to possibly reduce the incidence of this lethal fungal infection.
Audience Take Away:
The presentation will provide an insight into the various aspects of COVID-19 and mucormycosis syndemic including:
- Causes/predisposing factors
- Pathophysiology, clinical presentation & staging of rhino-orbito-cerebral mucormycosis (ROCM)
- Global guidelines for diagnosis & management of mucormycosis
- Prevention of ROCM in COVID-19 setting
