Mucormycosis In Post Covid Patients: A Systematic Review

Background Human species are facing a new crisis. The COVID19 pandemic has not only disrupted the health system of the entire world but has also put tremendous pressure on it. According to the CDC, mucormycosis (previously called zygomycosis) is a serious but rare fungal infection caused by a group of molds called mucormycetes. These molds live throughout the environment. Mucormycosis mainly affects people who have health problems or take medicines that lower the body's ability to fight germs and sickness. It is an aggressive fulminant invasive fungal infection that can occur in patients with diverse precipitating factors such as uncontrolled diabetes, renal failure, organ transplant, long‐term corticosteroid and immunosuppressive therapy, cirrhosis, burns, Acquired ImmunoDeficiency Syndrome and malignancies such as lymphomas and leukemias. Reportings of mucormycosis in covid patients have posed an additional apprehension and an onus on the already struggling government and health care workers. Objective Description of case series of mucormycosis in post COVID19 patients. Materials and Methods Systematic review of various studies reporting presence of mucormycosis in post covid patients was done. The study was conducted to assess the impact of mucormycosis on patients suffering from a virus. While searching keywords “covid” and “mucormycosis” on Google Scholar and internet, we found 9 studies which reported 13 post covid patients infected with mucormycosis. Result Mucormycosis can be divided into at least six clinical syndromes: rhino‐orbital‐cerebral, pulmonary, cutaneous, gastrointestinal, disseminated, and miscellaneous. Analysis of post covid patients showed four clinical manifestations‐ Rhino‐Orbital‐Cerebral Disease (3 research papers reporting one case each and 1 research paper with 4 patients); Pulmonary Disease (3 research papers with 4 cases); Gastrointestinal Disease (1 research paper with 1 case) and Disseminated (1 research paper with 1 case). Out of these total thirteen patients, seven were reported dead.S.No. Author Number of Patients Mucormycosis associated Clinical Syndrome Outcome 1. Mehta et al. 1 Rhino‐Orbital‐Cerebral Disease Exitus 2. Amanda et al. 1 Rhino‐Orbital‐Cerebral Disease Exitus 3. Mekonnen et al. 1 Rhino‐Orbital‐Cerebral Disease Exitus 4. Federico et al. 4 Rhino‐Orbital‐Cerebral Disease Discharged 5. Arnaud et al. 2 Pulmonary Disease 1‐ Exitus 1‐ Alive6. Epifanio et al. 1 Gastrointestinal Disease Exitus 7. Brian et al 1 Disseminated ExitusConclusion As per Worldometer approximately 88 million cases of COVID19 have been reported so far of which nearly 1.9 million succumbed to death. Although the reported data relating to presence of mucormycosis in Covid patients is very meagre, yet the fatality rate is more than fifty percent. The situation is alarming. Exhaustive studies need to be undertaken as delayed diagnosis and inadequate treatment may lead to higher risk of negative outcomes.