Upadhyay S, Bharara T, Khandait M, Chawdhry A, Sharma BB. Mucormycosis – resurgence of a deadly opportunist during COVID-19 pandemic: Four case reports. World J Clin Cases 2021; 9(36): 11338-11345 [PMID: 35071564 DOI: 10.12998/wjcc.v9.i36.11338]
Corresponding Author of This Article
Tanisha Bharara, MBBS, MD, Assistant Professor, Department of Microbiology, SGT University, Budhera Gurgaon, Gurugram 122505, Haryana, India. tanishabharara.med@gmail.com
Research Domain of This Article
Infectious Diseases
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Shalini Upadhyay, Tanisha Bharara, Manisha Khandait, Department ofMicrobiology, SGT University, Gurugram 122505, Haryana, India
Ankit Chawdhry, Department of Oral and Maxillofacial Surgery, SGT University, Gurugram 122505, Haryana, India
Bharat Bhushan Sharma, Department of Radiology, SGT University, Gurugram 122505, Haryana, India
Author contributions: Upadhyay S, Bharara T and Khandait M reviewed the literature and contributed to manuscript drafting; Upadhyay S, and Bharara T performed the microbiological analyses and interpretation; Chowdhry A was the oral and maxillofacial surgeon who took the history and performed detailed analysis of the cases; Sharma B analyzed and interpreted the imaging findings; Khandait M and Bharara T performed the revision of the manuscript for important intellectual content; all authors have read and approve the final manuscript.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tanisha Bharara, MBBS, MD, Assistant Professor, Department of Microbiology, SGT University, Budhera Gurgaon, Gurugram 122505, Haryana, India. tanishabharara.med@gmail.com
Received: April 17, 2021 Peer-review started: April 17, 2021 First decision: July 15, 2021 Revised: August 6, 2021 Accepted: November 5, 2021 Article in press: November 5, 2021 Published online: December 26, 2021 Processing time: 250 Days and 6.5 Hours
Abstract
BACKGROUND
Coronavirus disease 2019 (COVID-19) patients who suffer severe infection or comorbidities have an increased risk of developing fungal infections. There is a possibility that such infections are missed or misdiagnosed, in which case patients may suffer higher morbidity and mortality. COVID-19 infection, aggressive management strategies and comorbidities like diabetes render patients prone to opportunistic fungal infections. Mucormycosis is one of the opportunistic fungal infections that may affect treated COVID patients.
CASE SUMMARY
We present a case series of four adult males who were diagnosed with mucormycosis post-COVID-19 recovery. All the patients had diabetes and a history of systemic corticosteroids for treatment of COVID-19. The mean duration between diagnosis of COVID-19 and development of symptoms of mucor was 15.5 ± 14.5 (7–30) d. All patients underwent debridement and were started on antifungal therapy. One patient was referred to a higher center for further management, but the others responded well to treatment and showed signs of improvement at the last follow-up.
CONCLUSION
Early diagnosis and management of mucormycosis with appropriate and aggressive antifungals and surgical debridement can improve survival.
Core Tip: Mucormycosis usually indicates a serious underlying medical condition such as diabetes. Furthermore, the immune dysregulation post coronavirus disease 2019, and widespread use of immunosuppressants and broad-spectrum antibiotics may lead to enhanced susceptibility to a number of secondary opportunistic infections such as mucormycosis. Clinical suspicion along with prompt microbiological diagnosis are indispensable to a positive case outcome.
