Mucormycosis– an epidemic within pandemic in India

Recently 9k cases of Mucormycosis had been reported in India, which is huge increase compared to normal situation (fewer than 20 cases a year).Mostly the victims are the people those who are infected or recovering from with COVID-19. Although, the disease is not contagious (cannot spread from close contact), but it spreads through fungal spores which may be found in the environment, even in the air.In this pandemic time, it becomes alarming for the people those who have weaker immune system due to COVID-19 infection. According to the expert’s opinion, the overuse of drugs that suppress the immune system during the COVID-19 pandemic could be causing the surge. Although, COVID-19 is associated with a wide range of secondary fungal and bacterial infections, but second COVID wave has created a perfect environment for mucormycosis.

From current research report of the journal Diabetes & Metabolic Syndrome: Clinical Research & Reviews, several factors has been identified that creates an ideal atmosphere for contracting mucormycosis.High iron levels, diabetes, immunosuppression, low oxygen, as well as several other factors including prolonged hospitalization with mechanical ventilators and unsanitary conditions are the major factors that could increase the risk of developing infections.

Mucorales fungi belonging to the subphylum Mucoromycotina, order Mucorales, causes a life-threatening infection in human called Mucormycosis. These organisms found in soil, leaves, piles of compost, rotting wood.The infection is mostly developed in different organs of human such as eyes, faces, lungs, sinuses even in central nervous system. The fungus infection can be on skin with cutaneous exposure (cut or burn) too. The pathogens cause disease in the human host in two steps: first, the infecting microorganisms mutate themselves to evade the immune system of host, and then perturbation of the immune system to damage the host cells. Different virulence factors of mucorales involve in accomplishing the damage process in the host.

Mucormycosis is caused by exposure to mucormyete molds. Naturally, these types of molds can be present in the environment, butanyone carrying these molds will not get fungal infection. People with comparatively weakened immune system are at higher risk for developing this type of fungal infection. The infection risk may increase for the patients who have already gone through different conditions such as trauma and burns, cuts and scrapes, cancer, uncontrolled diabetes mellitus in ketoacidosis, malignant haematological disorders, recent organ transplant or bone marrow transplantation, HIV or AIDS, neutropenia surgery.Recently COVID-19 affected or recovered patients are also in high risk for mucormycosis.

Different types of diseases can be caused by Mucormycosis:
 Rhinocerebralmucormycosis:Infected area:Brain, Sinuses.Symptoms:sinus congestion, headache,
fever, swollen face one side, black lesions outside the face or inside the mouth).
 Pulmonary mucormycosis:Infected area:Lung, Symptoms: Disturbance in breathing, fever, chest
pain, and cough.
 Cutaneous mucormycosis: Infected area:skin, Symptoms: Swelling in infected skins, redness,
ulcers or blisters.
 Gastrointestinal mucormycosis: mostlydevelop in premature newborn babies. Symptoms: nausea,
vomiting, gastrointestinal bleeding, and abdominal pain;

 Disseminated mucormycosis: It can occur in patients having multiple medical complication from
other infectious disease.
 Recently identified mucormycosis due to COVID-19 related complications.

However, it becomes difficult to define the best wayof treatment for both COVID-19 and
mucormycosissimultaneously. The combined risks of mucormycosis and COVID-19 raise challenging issues and require careful coordination of patient care and treatment. Medical experts have raises some issues, “whether it is possible to prevent the fungal growth by antifungal side by side with COVID treatment?” or “Is there any way to reduce the COVID-19 infectionwithout suppressing the immune system so much such that the fungal infectioncannotdevelopin host?” These need to be addressed in order to get relief from upcoming crisis.

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