Title: COVID-19 and Mucormycosis – A synergy best avoided

Abstract:

“Prevention is better than cure” – never have these words meant more than the current times. While the nation was still in the tight clutches of COVID-19, we were dealt another hand of unprecedented morbidity – Mucormycosis.

Mucormycosis is an acute, invasive fungal infection caused by any fungal species within the order Mucorales in the Zygomycetes class. These fungi are ubiquitous in nature and have the potential to affect any organ system from the brain to the nose-paranasal sinuses, the lungs and the gastrointestinal tract. The predominant co-morbidity predisposing to Mucormycosis is diabetes and immunosuppression.

As is widely known now, immune suppression and widespread inflammation are the hallmark of COVID-19. Steroids were used in the setting of severe inflammation to combat it, which inadvertently sent the glycemic control for a toss. And this very combination of immune suppression and deranged glycemic control presented the perfected environment for mucorales to flourish.

Initially, patients presented with mucormycosis in the post-COVID period but the time of presentation shortened and patients began presenting as early as 7^th-8^th day after diagnosis of COVID-19. The symptoms at presentation varied from nasal obstruction, hemi-facial swelling to complete unilateral loss of vision. Nasal endoscopies and imaging studies too showed a lot of variation. Patients received multi-disciplinary surgical management followed by antifungal therapy.

Diagnosis and management of Mucormycosis is challenging, requiring a high index of suspicion and prompt action. The intent of this discussion is to spread awareness about the menace called mucormycosis to minimize morbidity in patients.