Mucormycosis - The black menace in COVID-19

The current outbreak of second wave of COVID-19 in India has seen the rise of opportunistic infections, a deadly one being mucormycosis or “black fungus.” As of now, there are over 9000 cases of this deadly disease which have been reported from several states in India. Nine states in India including Punjab, Uttar Pradesh, Rajasthan, and Bihar have declared mucormycosis as an epidemic. There are five types of mucormycosis – rhino-orbital-cerebral, pulmonary, gastrointestinal, cutaneous, and disseminated. Out of these, rhino-orbital-cerebral and pulmonary mucormycoses are most common in post-COVID patients. The clinical presentation of such patients include cough, fever, breathlessness, chest pain, sinusitis, pain on one side of the face with lack of sensation and proptosis of eye. Diagnosis could be done through analysis of clinical findings, direct microscopy, serum antigen tests, culture, histopathology, radio imaging, and polymerase chain reaction/matrix-assisted laser desorption ionization time-of-flight. Treatment will include preventive measures taken at home or at hospital for post-COVID patients. Medical treatment of mucormycosis mainly includes installing a central catheter (line), maintaining adequate systemic hydration, and infusion of normal intravenous saline before antifungal amphotericin B infusion. Since amphotericin is nephrotoxic, alternative drugs, such as posaconazole or isavuconazole, can be suggested. Adjuvant therapy with caspofungin, deferasirox, statins, aspirin, and hyperbaric oxygen may have to be considered as well. Extensive surgical debridement can also be suggested to remove all necrotic tissues. This review emphasizes the different aspects of mucormycosis such as epidemiology, etiopathogenesis, risk factors, diagnosis, preventive measures, and treatment strategies that can be adopted to tackle this fungal menace in COVID-19.