COVID-19-Associated mucormycosis: Case series from a tertiary care hospital in South India

The pandemic coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) is a global health problem. COVID-19 has given rise to a number of secondary bacterial or fungal infections. During the second wave of COVID-19, India experienced an epidemic of mucormycosis in COVID-19 patients. In this paper, we discuss the clinical features, investigations and management of four patients having COVID-19-associated mucormycosis (CAM), especially rhino-orbital mucormycosis (ROM) caused by Rhizopus arrhizus and Mucor species. We also compare the cases and their risk factors with previously reported CAM cases in India. Three patients had mucormycosis after recovering from COVID-19. They were successfully treated with surgical debridement and early initiation of anti-fungal therapy with systemic amphotericin B and other supportive measures such as broad-spectrum antibiotics, insulin infusion, antihypertensives and analgesics. The remaining patient had mucormycosis during COVID-19. He was admitted in the intensive care unit due to COVID-pneumonia and was on mechanical ventilation. In spite of all supportive measures, the patient succumbed to death due to cardiogenic shock. Three out of our four patients had diabetes mellitus. All patients were treated with systemic steroid during COVID-19 treatment. Diabetes mellitus and steroid treatment are the major risk factors for CAM. Early diagnosis of this life-threatening infection along with strict control of hyperglycemia is necessary for optimal treatment and better outcomes.