COVID-19-Associated Mucormycosis: An Opportunistic Fungal Infection. A Case Series and Review

• Published in: International journal of infectious diseases 2022-08, Vol.121, p.203-210
• Main Authors: Balushi, Asma Al, Ajmi, Ahmed Al, Sinani, Qais Al, Menon, Varna, Berieki, Zainab Al, Shezawi, Asma Al, Azri, Saleh Al, Rashdi, Azza Al, Jardani, Amina Al, Baluki, Thuwaiba Al, Ghaithi, Salem Al, Reesi, Ali Al, Al-Za'abi, Ahmed Talib, Al’ Balushi, Mohammed Abdullah, Maqbali, Talib Al
• Format: Article
• Language: English
• Subjects: COVID-19 - complications; COVID-19 associated mucormycosis; COVID-19 Testing; COVID-19 variants; Humans; Invasive mold infections; Mucorales; Mucormycosis - complications; Mucormycosis - diagnosis; Mucormycosis - drug therapy; Opportunistic Infections - complications; Opportunistic Infections - diagnosis; Opportunistic Infections - drug therapy; Review; Rhino-orbital-cerebral mucormycosis; Rhizopus oryzae; SARS-CoV-2
• ISSN: 1201-9712; 1878-3511
• DOI: 10.1016/j.ijid.2022.05.005

•Mucormycosis is an opportunistic angioinvasive infection with a high mortality rate.•A surge in mucormycosis cases has been observed during the second COVID-19 wave.•Diabetes mellitus, COVID-19, and hot climate increase the risk of mucormycosis.•Glycemic control and ketoacidosis prevention are key in managing mucormycosis. A surge in COVID-19-associated mucormycosis cases has been observed during the second wave of COVID-19 in summer of 2021. Most cases were reported from India. The Delta variant (B.1.617.2) was the most common variant circulating at that time. Mucormycosis is an opportunistic angioinvasive fungal infection with high morbidity and mortality. We present 10 cases of COVID-19-associated rhino-orbital and rhino-orbital-cerebral mucormycosis managed in a secondary hospital in Oman. The median time for developing mucormycosis was two weeks after COVID-19 diagnosis. All patients were newly diagnosed or already known to have poorly controlled diabetes mellitus. Five patients received corticosteroid therapy for COVID-19. Three patients had severe COVID-19 and died of severe acute respiratory distress syndrome and septic shock. Another three patients died of advanced mucormycosis and cerebral involvement. Despite aggressive medical and surgical intervention, the mortality rate was 60% (6/10). Mucormycosis is an aggressive opportunistic infection with high morbidity and mortality that requires prompt recognition and urgent intervention. Uncontrolled blood sugar, the use of corticosteroids, and immune dysfunction due to COVID-19 are all important risk factors for development of mucormycosis. Worse outcomes are associated with poor glycemic control despite aggressive medical and surgical interventions.