Indian Journal of Pharmacy and Pharmacology

Print ISSN: 2393-9079

Online ISSN: 2393-9087


Indian Journal of Pharmacy and Pharmacology (IJPP) open access, peer-reviewed quarterly journal publishing since 2014 and is published under auspices of the Innovative Education and Scientific Research Foundation (IESRF), aim to uplift researchers, scholars, academicians, and professionals in all academic and scientific disciplines. IESRF is dedicated to the transfer of technology and research by publishing scientific journals, research content, providing professional’s membership, and conducting conferences, seminars, and award programs.

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Setia and Bhattacharya: Mucormycosis and its implication in COVID-19


Mucormycosis is an extremely rare disease.1 Major cause of mucor mold includes dirt trees, compost, rotting vegetables, and fruits.2 Mucormycosis is triggered by a family of moulds in the order Mucorales. Rhizopus spp., Mucor spp., and Lichtheimia spp. (formerly of the genera Absidia and Mycocladus) are the most commonly found organisms in mucormycosis, followed by Rhizomucor spp., Cunninghamella spp., Apophysomyces spp., and Saksenaea spp.3 It is common and can be detected in dirt, air, and even in noses and mucus. It influences the sinuses, the brain, and the lungs, although it can be fatal for diabetic patients or individuals who are seriously immunocompromised, such as cancer victims or people with HIV/AIDS.4 Mucormycosis is a disease that has been identified throughout the world.5 This virus has the ability to affect people of all ages, particularly premature babies. Such typical signs involve tissue loss (necrosis) of the roof of the mouth (palate), disintegration of the thin cartilage and bone (septum) wall that separates the nostrils (septum), swelling of the site all around nose (perinasal area), and redness (erythema) of the skin overlying the sinus and the eye socket (orbit).6 Owing to a loss of oxygen, there may be bluish discoloration of the skin near the sinuses or the eye socket (cyanosis). Blurred or double vision may occur at times. Serious tissue loss (necrosis) may arise if the infection goes undetected, and the infection may severely affect facial structures. Many individuals who have recovered from COVID-19 have recently been diagnosed with black fungus or mucormycosis disease.7 The infection infiltrates the sinuses and spreads to the intraorbital and intracranial areas. If the disease progresses unchecked, 50-80 percent of patients will die.8 A high likelihood of mucormycosis was found in a COVID-19 patient with unregulated diabetes and diabetic ketoacidosis, patients that have administered large doses of intravenous or oral steroids for extended periods of time, as well as patients who have undergone immunomodulators (drugs used in disorders such as cancer to alter the immune system's response), are more susceptible to black fungus.9 Clinically, rhinocerebral mucormycosis can manifest with atypical signs and symptoms resembling complicated sinusitis, such as nasal blockage, crusting, proptosis, and fever.10 In most cases, rhino-orbital-cerebral infection begins in the paranasal sinuses, causing bone loss and eventual penetration of the orbit, eye, and brain.11 Fever, cough, chest pain, blood in sputum after coughing, and deteriorating respiratory problems are all symptoms of pulmonary mucormycosis (involving the chest).12 The most prevalent types of mucormycosis in immunocompetent patients are cutaneous and soft-tissue mucormycosis.13 Cutaneous and soft-tissue mucormycosis are the most prevalent types of mucormycosis in immunocompetent patients,14 occurring mainly as a result of skin damage caused by serious injury (e.g., natural disasters, motor vehicle collisions, improvised explosive devices in theatres of war, or iatrogenic sources), surgery, or burns. Moreover, Covid-19 is a potentially fatal infectious disease, infected patients have an increase in inflammatory cytokines and reduced cell-mediated immunity, with lower CD4+ T and CD8+ T cells counts,15 suggesting vulnerability to fungal co-infections. Patients who were seriously ill, including those confined to intensive care units and those who needed mechanical ventilation, or who had prolonged hospital stays, including up to 50 days, were more likely to develop fungal co-infections.16 Excessive use of steroids in the treatment of Covid-19 can also inhibit immunity, causing opportunistic fungal infections to colonise.17 The detection of distinctive signs, a comprehensive case history, a rigorous clinical assessment, and a number of advanced examinations are used to make a diagnosis of mucormycosis.18 Mucormycosis is difficult to diagnose and the symptoms are shared among a variety of diseases, including several forms of infection.19 Mold in infected tissue is used to make a diagnosis, which is often confirmed by a test called a fungal culture.20 A timely diagnosis is critical so that recovery can continue as soon as possible. Mucormycosis is a dangerous infection that requires antifungal medication, typically amphotericin B, posaconazole, or isavuconazole.21 These medications are administered either intravenously (amphotericin B, posaconazole, isavuconazole) or orally (amphotericin B, posaconazole, isavuconazole).22 Other medications, such as fluconazole, voriconazole, and echinocandins, do not work against the fungi that cause mucormycosis.23 Mucormycosis frequently necessitates surgery to remove the infected tissue.24 Polyenes (amphotericin formulations) and triazoles are the two major types of antifungal drugs used to treat mucormycosis (isavuconazole and posaconazole).25 The two agents currently approved by the FDA for the primary treatment of mucormycosis are amphotericin B and isavuconazole.26 Posaconazole can be used off-label for salvage treatment in patients intolerant to amphotericin B.27 It has also been used as step-down therapy after initial control of the disease with amphotericin. Liposomal amphotericin B at a dosage of 5–10 mg/kg per day is currently recommended for the treatment of mucormycosis.28 In the absence of intervention of the central nervous system, a dosage of 5 mg/kg is recommended. Liposomal amphotericin at 3 mg/kg/day was similarly successful but safer and better tolerated than 10 mg/kg/day in a randomised controlled study of 201 patients with invasive mould disease.29 In conclusion, doctors caring for seriously ill COVID-19 patients must be mindful of dangerous diseases that can hinder COVID-19 care. To improve results in mucormycosis, early diagnosis and timely management are needed.30


Novel coronavirus affects many life worldwide. A second wave of virus rapidly spreading known as black fungus (mucormycosis). Many individuals who have recovered from COVID-19 have recently been diagnosed with black fungus or mucormycosis disease. Mucormycosis is difficult to diagnose and the symptoms are shared among a variety of diseases, including several forms of infection. Mold in infected tissue is used to make a diagnosis, which is often confirmed by a test called a fungal culture. As such no proper vaccine or medication is available for black fungus. The two agents currently approved by the FDA for the primary treatment of mucormycosis are amphotericin B and isavuconazole.

Conflict of Interest




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© This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Aseem Setia, Sankha Bhattacharya

Article History

Received : 19-05-2021

Accepted : 21-05-2021

Available online : 17-06-2021

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