Indian Journal of Pharmacy and Pharmacology

Print ISSN: 2393-9079

Online ISSN: 2393-9087

CODEN : IJPPTK

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.

With more...


  • Article highlights
  • Article tables
  • Article images

Article statistics

Viewed: 411

PDF Downloaded: 272


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


Introduction

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

Conclusion

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

None.

References

1 

B Razem Y Dennai F Slimani Chronical rhino-orbital mucormycosis in an immunocompetent host: A case reportInt J Surg Case Rep20218210588210.1016/j.ijscr.2021.105882

2 

J Delgado-Ospina JB Molina-Hernández Cl Chaves-López G Romanazzi A Paparella The Role of Fungi in the Cocoa Production Chain and the Challenge of Climate ChangeJ Fungi20217320210.3390/jof7030202

3 

G Nagy S Kiss R Varghese K Bauer C Szebenyi Characterization of Three Pleiotropic Drug Resistance Transporter Genes and Their Participation in the Azole Resistance of Mucor circinelloidesFront Cell Infect Microbiol20211166034710.3389/fcimb.2021.660347

4 

VS Salian JA Wright PT Vedell S Nair C Li COVID-19 Transmission, Current Treatment, and Future Therapeutic StrategiesMol Pharm202118375471

5 

S Patil D Sarate S Chopade M Khade S Dhage S Kangate Emerging Challenge of Mucormycosis in post COVID PatientsIAR J Med Case Rep20212371010.47310/iarjmcr.2021.v02i03.002

6 

OE Ogle Advanced Intraoral Surgery, An Issue of Oral and Maxillofacial Surgery Clinics of North AmericaVol. 33Elsevier Health Sciences2021

7 

S Sharma M Grover S Bhargava S Samdani T Kataria Post coronavirus disease mucormycosis: a deadly addition to the pandemic spectrumJ Laryngol Otol202113554427

8 

JR Bilyk AP Murchison Ocular Adnexal Lymphoproliferative DiseaseSmith and Nesi’s Ophthalmic Plastic and Reconstructive Surgery2021769816

9 

A Werthman-Ehrenreich Mucormycosis with orbital compartment syndrome in a patient with COVID-19Am J Emerg Med202142264.e510.1016/j.ajem.2020.09.032

10 

C M Tong K Kurji Blepharitis: Overview and ClassificationCornea, E-Book2021308

11 

S Gupta Orbital inflammationSmith and Nesi’s Ophthalmic Plastic and Reconstructive SurgerySpringer202174368

12 

T Singhal The Chronic Effects of COVID-19 or “Long COVIDIndian Practit20217442431

13 

KM Coerdt EG Zolper AG Starr KL Fan CE Attinger KK Evans Cutaneous mucormycosis of the lower extremity leading amputation in two diabetic patientsArch Plast Surg202148231610.5999/aps.2020.00549

14 

A Amanati H Barzegar G Pouladfar AS Dashti M Abtahi B Khademi Orbital mucormycosis in immunocompetent children; review of risk factors, diagnosis, and treatment approachBMC Infect Dis202020119

15 

X Bo CY Fan AL Wang YL Zou YH Yu C He Suppressed T cell-mediated immunity in patients with COVID-19: a clinical retrospective study in Wuhan, ChinaJ Infect20208115160

16 

G Zhang C Hu L Luo F Fang Y Chen J Li Clinical features and outcomes of 221 patients with COVID-19 in Wuhan, ChinaJ Clin Virol202012710436410.1016/j.jcv.2020.104364

17 

EG Favalli F Ingegnoli O Lucia G Cincinelli R Cimaz R Caporali COVID-19 infection and rheumatoid arthritis: Faraway, so close! Autoimm rRv2020195102523

18 

PG Pappas DR Boulware DP Kontoyiannis MH Miceli L Ostrosky-Zeichner A Spec Clinical mycology today: A synopsis of the mycoses study group education and research consortium (MSGERC) second biennial meetingMed Mycol20205855698

19 

Z Chegini M Didehdar A Khoshbayan S Rajaeih M Salehi A Shariati Epidemiology, clinical features, diagnosis and treatment of cerebral mucormycosis in diabetic patients: A systematic review of case reports and case seriesMycoses20206312126482

20 

M Hoenigl J Salmanton-García TJ Walsh M Nucci CF Neoh JD Jenks Global guideline for the diagnosis and management of rare mould infections: an initiative of the European Confederation of Medical Mycology in cooperation with the International Society for Human and Animal Mycology and theLancet Infect Dis202110.1016/S1473-3099(20)30784-2

21 

R Miller L Farrugia J Leask K Khalsa N Khanna L Melia Successful treatment of Rhizopus arrhizus rhino-orbital-cerebral mucormycosis with isavuconazole salvage therapy following extensive debridementMed Mycol Case Rep20213239420.1016/j.mmcr.2021.03.005

22 

S Sinha A Sehgal R Sehgal Association of ACE2 receptor and ACEIs/ARBs with disease severity in COVID-19Drug Discov Ther2020141617010.5582/ddt.2020.03064

23 

SJ Livengood RH Drew JR Perfect Combination Therapy for Invasive Fungal InfectionsCurr Fungal Infect Rep20201440910.1007/s12281-020-00369-4

24 

P Jeyaraj Sino-Maxillary Mucormycosis of Iatrogenic Etiology in an Immunocompetent Patient-Importance of Early Diagnosis and Prompt Management20212118

25 

A Gómez-López Antifungal therapeutic drug monitoring: focus on drugs without a clear recommendationClin Microbiol Infect202026111481710.1016/j.cmi.2020.05.037

26 

T Gebremariam S Alkhazraji A Alqarihi NP Wiederhold KJ Shaw TF Patterson Fosmanogepix (APX001) is effective in the treatment of pulmonary murine mucormycosis due to Rhizopus arrhizusAntimicrob Agents Chemother2020646e0017820

27 

Y Liang X Chen J Wang C Guo F Liu J Yang Oral posaconazole and bronchoscopy as a treatment for pulmonary mucormycosis in pediatric acute lymphoblastic leukemia patient: A case reportMedicine (Baltimore)20211006:e24630

28 

M Jestin E Azoulay F Pène F Bruneel J Mayaux M Murgier Poor outcome associated with mucormycosis in critically ill hematological patients: results of a multicenter studyAnn Intensive Care20211113110.1186/s13613-021-00818-4

29 

C Faustino L Pinheiro Lipid Systems for the Delivery of Amphotericin B in Antifungal TherapyPharmaceutics20201212910.3390/pharmaceutics12010029

30 

D Garg V Muthu IS Sehgal R Ramachandran H Kaur A Bhalla Coronavirus disease (Covid-19) associated mucormycosis (CAM): case report and systematic review of literatureMycopathologia2021186228998



jats-html.xsl

© 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.


Article type

Editorial


Article page

97-99


Authors Details

Aseem Setia, Sankha Bhattacharya


Article History

Received : 19-05-2021

Accepted : 21-05-2021

Available online : 17-06-2021


Article Metrics


View Article As

 


Downlaod Files

   








Wiki in hindi