Open Access Open Access  Restricted Access Subscription or Fee Access

Covid-19 Associated Mucormycosis: Urgency To Reconsider The Uncontrolled Use Of Prophylactic Drugs

Chandani Kamble, Vikas Kamble, Sharad Kamble, Prakash Kamble, Rani Kamble


Mucormycosis, a lethal mycosis, has affected hundreds of COVID-19 sufferers in India. Mucormycosis, previously known as zygomycosis, is due to the diverse fungi that belong to the family "Mucorales." These molds are normally determined in soil, air, and damp partitions and often colonize oral mucosa, nose, paranasal sinuses, and throat. The pathophysiological results of diabetes mixed with the intense inflammatory surge in COVID-19 and steroid remedy weaken a person's immunity and render susceptibility to fungal infections. Patients treated for intense COVID-19 have damaged lungs and suppressed systems, and surroundings that help mycosis. Fungal spores can develop in airlines or sinuses, and invade bodies' tissues, explaining why the hollow space and paranasal sinuses are the most not unusual place site of mucormycosis contamination, the consequential unfold to the eyes can lead to blindness, or inflicting complications or seizures if the contamination spreads to the brain. Poorly managed diabetes frequently results in acidosis in tissues the appropriate surroundings for Mucorales fungi to develop, exacerbating the risk for mucormycosis. This will become clinically important, mainly in India that has an accelerated incidence of undiagnosed and out-of-control diabetes. Given that a large growth in the cases of mucormycosis in the diabetic patients treated for COVID-19 is strongly associated with corticosteroid administration, there may be a demand to evaluate the use of nutritional nutraceuticals with immune-boosting potentials that modulate metabolic abnormalities in the control of COVID-19 related mucormycosis.



Black fungus, COVID-19, Corticosteroid therapy, Diabetes mellitus, Immunosuppression, Mucormycosis

Full Text:



Hanley, B, Naresh, KN, Roufosse, C, et al. Histopathological findings and viral tropism in UK patients with severe fatal COVID-19: a post-mortem study. Lancet Microbe 2020; 1(6): e245–e253.

Song, G, Liang, G, Liu, W. Fungal co-infections associated with global COVID-19 pandemic: a clinical and diagnostic perspective from China. Mycopathologia 2020; 185(4): 599–606.

Tavakolpour, S, Rakhshandehroo, T, Wei, EX, et al. Lymphopenia during the COVID-19 infection: what it shows and what can be learned. ImmunolLett 2020; 225: 31–32.

Rodriguez-Morales, AJ, Cardona-Ospina, JA, Gutierrez-Ocampo, E, et al. Clinical, laboratory and imaging features of COVID-19: a systematic review and meta-analysis. Travel Med Infect Dis 2020; 34: 101623.

Vasquez-Bonilla, WO, Orozco, R, Argueta, V, et al. A review of the main histopathological findings in coronavirus disease 2019. Hum Pathol 2020; 105: 74–83.

Short, KR, Kroeze, E, Fouchier, RAM, et al. Pathogenesis of influenza-induced acute respiratory distress syndrome. Lancet Infect Dis 2014; 14(1): 57–69.

Arabi, YM, Mandourah, Y, Al-Hameed, F, et al. Corticosteroid therapy for critically ill patients with Middle East respiratory syndrome. Am J RespirCrit Care Med 2018; 197(6): 757–767.

Stockman, LJ, Bellamy, R, Garner, P. SARS: systematic review of treatment effects. PLoS Med 2006; 3(9): e343.

Rodrigo, C, Leonardi-Bee, J, Nguyen-Van-Tam, J, et al. Corticosteroids as adjunctive therapy in the treatment of influenza. Cochrane Database Syst Rev 2019Feb24;2(2):CD010406.

Werthman-Ehrenreich, A. Mucormycosis with orbital compartment syndrome in a patient with COVID-19. Am J Emerg Med 2021; 42: 264.e5–264.e8.

Placik, DA, Taylor, WL, Wnuk, NM. Bronchopleural fistula development in the setting of novel therapies for acute respiratory distress syndrome in SARS-CoV-2 pneumonia. Radiol Case Rep 2020; 15(11): 2378–2381.

Kanwar, A, Jordan, A, Olewiler, S, et al. A fatal case of Rhizopusazygosporus pneumonia following COVID-19. J Fungi (Basel) 2021; 7(3): 174.

Dallalzadeh, LO, Ozzello, DJ, Liu, CY, et al. Secondary infection with rhino-orbital cerebral mucormycosis associated with COVID-19. Orbit. 2021Mar23;1–4. DOI: 10.1080/01676830.2021.1903044.

Johnson, AK, Ghazarian, Z, Cendrowski, KD, et al. Pulmonary aspergillosis and mucormycosis in a patient with COVID-19. Med Mycol Case Rep 2021; 32: 64–67.

Khatri, A, Chang, KM, Berlinrut, I, et al. Mucormycosis after coronavirus disease 2019 infection in a heart transplant recipient–case report and review of literature. J Mycol Med 2021; 31(2): 101125.

John, TM, Jacob, CN, Kontoyiannis, DP. When uncontrolled diabetes mellitus and severe COVID-19 converge: the perfect storm for mucormycosis. J Fungi (Basel) 2021; 7(4): 298.

Zurl, C, Hoenigl, M, Schulz, E, et al. Autopsy proven pulmonary mucormycosis due to Rhizopusmicrosporus in a critically ill COVID-19 patient with underlying hematological malignancy. J Fungi (Basel) 2021; 7(2): 88.

Monte Junior, ESD, Santos, M, Ribeiro, IB, et al. Rare and fatal gastrointestinal mucormycosis (Zygomycosis) in a COVID-19 patient: a case report. ClinEndosc 2020; 53(6): 746–749.

Waizel-Haiat, S, Guerrero-Paz, JA, Sanchez-Hurtado, L, et al. A case of fatal rhino-orbital mucormycosis associated with new onset diabetic ketoacidosis and COVID-19. Cureus 2021; 13(2): e13163.

Pasero, D, Sanna, S, Liperi, C, et al. A challenging complication following SARS-CoV-2 infection: a case of pulmonary mucormycosis. Infection. 2021Oct;49(5):1055–1060.

Bellanger, AP, Navellou, JC, Lepiller, Q, et al. Mixed mold infection with Aspergillusfumigatus and Rhizopusmicrosporus in a severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) patient. Infect Dis Now. 2021Oct;51(7):633–635. DOI: 10.1016/j.idnow.2021.01.010.

Ahmadikia, K, Hashemi, SJ, Khodavaisy, S, et al. The double-edged sword of systemic corticosteroid therapy in viral pneumonia: a case report and comparative review of influenza-associated mucormycosis versus COVID-19 associated mucormycosis. Mycoses. 2021Aug;64(8):798–808.

Karimi-Galougahi, M, Arastou, S, Haseli, S. Fulminant mucormycosis complicating coronavirus disease 2019 (COVID-19). Int Forum Allergy Rhinol. 2021Jun;11(6):1029–1030.

Veisi, A, Bagheri, A, Eshaghi, M, et al. Rhino-orbital mucormycosis during steroid therapy in COVID-19 patients: a case report. Eur J Ophthalmol. 2021Apr10;11206721211009450.Mehta, S, Pandey, A. Rhino-orbital mucormycosis associated with COVID-19. Cureus 2020; 12(9): e10726.

Sen, M, Lahane, S, Lahane, TP, et al. Mucor in a viral land: a tale of two pathogens. Indian J Ophthalmol 2021; 69(2): 244–252.

Garg, D, Muthu, V, Sehgal, IS, et al. Coronavirus disease (Covid-19) associated mucormycosis (CAM): case report and systematic review of literature. Mycopathologia 2021; 186(2): 289–298.

Moorthy, A, Gaikwad, R, Krishna, S, et al. SARS-CoV-2, Uncontrolled diabetes and corticosteroids-an unholy trinity in invasive fungal infections of the maxillofacial region? A retrospective, multi-centric analysis. J Maxillofac Oral Surg. 2021Mar6;20(3):1–8.

Sarkar, S, Gokhale, T, Choudhury, SS, et al. COVID-19 and orbital mucormycosis. Indian J Ophthalmol 2021; 69(4): 1002–1004.

Sharma, S, Grover, M, Bhargava, S, et al. Post coronavirus disease mucormycosis: a deadly addition to the pandemic spectrum. J Laryngol Otol. 2021May;135(5):442–447.

Saldanha, M, Reddy, R, Vincent, MJ. Paranasalmucormycosis in COVID-19 patient. Indian J Otolaryngol Head Neck Surg. 2021Apr22;1–4. DOI: 10.1007/s12070-021-02574-0.

Revannavar, SM, Supriya, PS, Samaga, L, et al. COVID-19 triggering mucormycosis in a susceptible patient: a new phenomenon in the developing world? BMJ Case Rep 2021; 14(14): e241663.

Maini, A, Tomar, G, Khanna, D, et al. Sino-orbital mucormycosis in a COVID-19 patient: a case report. Int J Surg Case Rep 2021; 82: 105957.

Ravani, SA, Agrawal, GA, Leuva, PA, et al. Rise of the phoenix: mucormycosis in COVID-19 times. Indian J Ophthalmol 2021; 69(6): 1563–1568.

Lamoth, F, Lewis, RE, Walsh, TJ, et al. Navigating the uncertainties of COVID-19 associated aspergillosis (CAPA): a comparison with influenza associated aspergillosis (IAPA). J Infect Dis. 2021Mar26;jiab163. DOI: 10.1093/infdis/jiab163.

Group, RC, Horby, P, Lim, WS, et al. Dexamethasone in hospitalized patients with Covid-19. N Engl J Med 2021; 384(8): 693–704.

Kwak, EJ, Kim, DJ, Nam, W, et al. Mucormycosis in the jaw: a report of 2 cases and literature review. Oral Health Prev Dent 2020; 18(1): 1011–1016.

Spellberg, B, Edwards, J, Ibrahim, A. Novel perspectives on mucormycosis: pathophysiology, presentation, and management. ClinMicrobiol Rev 2005; 18(3): 556–569.

RajendraSantosh, AB, Muddana, K, Bakki, SR. Fungal infections of oral cavity: diagnosis, management, and association with COVID-19. SN ComprClin Med. 2021Mar27;1–12. DOI: 10.1007/s42399-021-00873-9.

Verma, DK, Bali, RK. COVID-19 and mucormycosis of the craniofacial skeleton: causal, contributory or coincidental? J Maxillofac Oral Surg. 2021Mar27;20(2):1–2. DOI: 10.1007/s12663-021-01547-8.

Mejia Buritica, L, KardussUrueta, AJ. Pulmonary mucormycosis. N Engl J Med 2021; 384(18): e69.

Mekonnen, ZK, Ashraf, DC, Jankowski, T, et al. Acute invasive rhino-orbital mucormycosis in a patient with COVID-19-associated acute respiratory distress syndrome. Ophthalmic PlastReconstrSurg 2021; 37(2): e40–e80.

Szarpak, L. Mucormycosis–a serious threat in the COVID-19 pandemic? J Infect. 2021Aug;83(2):237–279.

Gangneux, JP, Bougnoux, ME, Dannaoui, E, et al. Invasive fungal diseases during COVID-19: we should be prepared. J Mycol Med 2020; 30(2): 100971.

Stemler, J, Hamed, K, Salmanton-Garcia, J, et al. Mucormycosis in the Middle East and North Africa: analysis of the FungiScope registry and cases from the literature. Mycoses 2020; 63(10): 1060–1068.

Nucci, M, Engelhardt, M, Hamed, K. Mucormycosis in South America: a review of 143 reported cases. Mycoses 2019; 62(9): 730–738.

Pena, CE. Deep mycotic infections in Colombia. A clinicopathologic study of 162 cases. Am J ClinPathol 1967; 47(4): 505–520.

Alekseyev, K, Didenko, L, Chaudhry, B. Rhinocerebralmucormycosis and COVID-19 pneumonia. J Med Cases 2021; 12(3): 85–89.

Miller, MA, Molina, KC, Gutman, JA, et al. Mucormycosis in hematopoietic cell transplant recipients and in patients with hematological malignancies in the era of new antifungal agents. Open Forum Infect Dis 2021; 8(2): ofaa646.

Cornely, OA, Alastruey-Izquierdo, A, Arenz, D, et al. Global guideline for the diagnosis and management of mucormycosis: an initiative of the European Confederation of Medical Mycology in cooperation with the Mycoses Study Group Education and Research Consortium. Lancet Infect Dis 2019; 19(12): e405–e421.

Honavar, SG. Code mucor: guidelines for the diagnosis, staging and management of rhino-orbito-cerebral mucormycosis in the setting of COVID-19. Indian J Ophthalmol 2021; 69(6): 1361–1365.

Saaavedra-Trujillo, CH. Consensocolombiano de atención, diagnóstico y manejo de la infecciónpor SARS-COV-2/COVID-19 en establecimientos de atención de la salud–recomendacionesbasadas en consenso de expertos e informadas en la evidencia. Infectio 2020; 24(3): 1–102.

Steinbrink, JM, Miceli, MH. Mucormycosis. Infect Dis Clin North Am 2021; 35(2): 435–452.

Peixoto, D, Gagne, LS, Hammond, SP, et al. Isavuconazole treatment of a patient with disseminated mucormycosis. J ClinMicrobiol 2014; 52(3): 1016–1019.

Marty, FM, Ostrosky-Zeichner, L, Cornely, OA, et al. Isavuconazole treatment for mucormycosis: a single-arm open-label trial and case-control analysis. Lancet Infect Dis 2016; 16(7): 828–837.

Marques, GN, Silva, NU, Leal, MO, et al. The use of posaconazole delayed-release tablets in the successful treatment of suspected mucormycosis in a bottlenose dolphin (Tursiopstruncatus) calf. Med Mycol Case Rep 2021; 32: 77–80.

Perfect, JR, Cornely, OA, Heep, M, et al. Isavuconazole treatment for rare fungal diseases and for invasive aspergillosis in patients with renal impairment: challenges and lessons of the VITAL trial. Mycoses 2018; 61(7): 420–429.


  • There are currently no refbacks.

Copyright (c) 2022 Research & Reviews: Journal of Medicine

This Journal archive has been shifted to