Mucormycosis in COVID-19 Pandemic

Abstract

Background
 Coronavirus disease-2019 (COVID-19) has been associated with a wide range of opportunistic fungal infections. Many coun
tries have seen an unprecedented rise in cases of COVID-19-associated mucormycosis (CAM). The purpose of this study is to 
identify the correlation between the COVID-19 epidemic and mucormycosis. Our study also provides details on factors causing 
CAM. 
Methods
 A retrospective study from November 2020 to February 2022 includes four cases of COVID-19-associated rhino-orbital mu
cormycosis treated at Habib Thameur Hospital’s ENT Department.
 Results
 The mean age of patients was 67.5-years, 75% were males, and the most frequent underlying conditions were diabetes mellitus 
(100%). The median time interval between the diagnosis of COVID-19 and the first evidence of mucormycosis infection was 
15-days; two patients required hospitalization in a COVID unit, and two patients received oxygen therapy at home. All patients 
received corticosteroid therapy at a dose of 1 mg/kg/d for an average of 10-days. Treatment using antifungals and surgery was 
described in all the patients. Amphotericin B deoxycholate was used in 75% and lipid formulation in 25%. Two patients pre
sented renal insufficiency due to amphotericin B; the doses were adapted with good evolution. In that report, the case fatality 
rate was 75%.
 Conclusion
 Mucormycosis is a fatal fungal infection that usually affects patients with altered immunity. Several cases of mucormycosis in 
people with COVID-19 have been increasingly reported worldwide. Diabetes mellitus (DM), steroid overdose, immunosuppres
sion, and high iron levels, combined with other factors such as prolonged hospitalization, unhygienic conditions, and the use 
of ventilators, combine to create an ideal environment for contracting mucormycosis. Lastly, there is a need to create awareness 
about fungal diseases among clinicians in order to help identify early symptoms and restrict the spread of lethal fungal diseases. 
A collaborative team of otolaryngologists, ophthalmologists, anesthesiologists, and resuscitators will be required in hospitals to 
accelerate optimal management.