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International Research Journal of Medical Sciences and Health Care

Open Access Peer Review International
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Systematic Narrative Analysis of COVID-19-Associated Mucormycosis in India: Pathophysiological Mechanisms, Epidemiological Patterns, and Clinical Impact Assessment

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Dr. Rizky Wicaksono 1 , Dr. Putri Lestari 1 ,
4 Faculty of Engineering Institut Teknologi Bandung (ITB), Bandung, Indonesia
4 Department of Management Universitas Airlangga, Surabaya, Indonesia

Abstract

COVID-19-associated mucormycosis (CAM) emerged as a critical opportunistic fungal infection during the COVID-19 pandemic, particularly in India during the second wave. This systematic narrative analysis synthesizes existing clinical, epidemiological, and pathophysiological evidence to examine the determinants, progression, and outcomes of CAM. The study explores how SARS-CoV-2 infection, uncontrolled diabetes mellitus, corticosteroid therapy, and healthcare-related environmental factors collectively contributed to the surge in mucormycosis cases. Evidence indicates that immune dysregulation, hyperglycemia-induced fungal proliferation, and endothelial damage play central roles in disease progression. Studies also highlight the high mortality associated with rhino-orbital-cerebral mucormycosis in COVID-19 patients, with rapid clinical deterioration requiring early diagnosis and aggressive intervention (Alekseyev et al., 2021). Epidemiological patterns reveal clustering of cases in high-diabetes-prevalence populations and in settings with prolonged oxygen therapy or steroid misuse. The findings underscore the need for integrated infectious disease surveillance, rational steroid use, and early antifungal treatment strategies. This review provides a comprehensive framework for understanding CAM and offers clinical and public health recommendations for future outbreak preparedness.

Keywords

COVID-19, mucormycosis, India, rhino-orbital fungal infection

References

Alekseyev K, Didenko L, Chaudhry B. Rhinocerebral mucormycosis and COVID-19 pneumonia. J Med Cases. 2021;12(3):85-9.
Afroze NS, Korlepara R, Rao GV, Madala J. Mucormycosis in a diabetic patient: a case report with an insight into its pathophysiology. Contemp Clin Dent. 2017;8(4):662-6.
Balsari S, Udwadia Z, Shaikh A, Ghafur A, Kataria S. Contextualising evidence-based recommendations for the second wave of the COVID-19 pandemic in India. Lancet Infect Dis. 2021;21(7):905-907.
Bayram N, Ozsaygili C, Sav H. Susceptibility of severe Covid-19 patients to rhino-orbital mucormycosis fungal infection in different clinical manifestations. Jpn J Ophthalmol. 2021;65(4):515-525.
Bhatt K, Argolli A, Patel MH, et al. High mortality co-infections of COVID-19 patients: mucormycosis and other fungal infections. Discoveries. 2021;9(1):e126.
Bhogireddy R, Krishnamurthy V, Lal Jabaris S SL, Pullaiah CP, Manohar S. Is mucormycosis an inevitable complication of Covid-19 in India? Braz J Infect Dis. 2021;25(3):101597.
Chakrabarti A, Patel A, Soman R, et al.; National Task Force for COVID-19. Evidence Based Advisory in the Time of Covid-19. Ministry of Health and Family Welfare Government of India. Dept. of Health Research. Accessed July 15, 2021. https://www.icmr.gov.in/pdf/covid/techdoc/Mucormycosis_ADVISORY_FROM_ICMR_In_COVID19_time.pdf
Chitguppi R. What is causing mucormycosis – Covid19 or tocilizumab? Researchgate [Preprint]. 2021.
De A, Sinha S. Can spurt in black fungus cases be blamed on industrial oxygen cylinders, dirty water in humidifiers? India Today. Published May 26, 2021. Accessed July 30, 2021. https://www.indiatoday.in/coronavirus-outbreak/story/black-fungus-cases-industrial-oxygen-cylinders-humidifiers-covid-19-1807099-2021-05-26
DNA Web Team. DNA explainer: how second wave of COVID-19 pandemic has been more dangerous than first. DNA. Updated July 3, 2021. Accessed July 26, 2021. https://dnaindia.com/explainer/report-dna-explainer-how-second-wave-of-covid-19-pandemic-has-been-more-dangerous-than-first-289872816
Deutsch PG, Whittaker J, Prasad S. Invasive and non-invasive fungal rhinosinusitis – a review and update of the evidence. Medicina. 2019;55(7):319.
Garg D, Muthu V, Sehgal IS, et al. Coronavirus disease (Covid-19) associated mucormycosis (CAM): Case report and systematic review of literature. Mycopathologia. 2021;186(2):289-98.
Garg M, Maralakunte M, Garg S, et al. The conundrum of ‘Long-Covid-19’: A narrative review. Int J Gen Med. 2021;14:2491–2506.
Hagen A. How dangerous is the delta variant (B.1.617.2)? American Society for Microbiology. Published July 30, 2021. Accessed July 27, 2021. https://asm.org/Articles/2021/July/How-Dangerous-is-the-Delta-Variant-B-1-617-2
Horby P, Lim WS, Emberson JR, et al.; RECOVERY Collaborative Group. Dexamethasone in hospitalized patients with COVID-19. N Engl J Med. 2021;384(8):693-704.
Kapur M. How dangerous is the Covid-19 delta variant? Quartz India. Published June 29, 2021. Accessed July 27, 2021. https://qz.com/india/2024190/how-dangerous-are-covid-19-delta-and-delta-plus-variants
Kaur B. Health: Covid-19: Did India read mucormycosis right? Down To Earth. Published June 18, 2021. Accessed July 20, 2021. https://www.downtoearth.org.in/news/health/covid-19-did-india-read-mucormycosis-right--775375
Kimmig LM, Wu D, Gold M, et al. IL6 inhibition in critically ill COVID-19 patients is associated with increased secondary infections Front Med. 2020;7:583897.
Lv L, Gu S, Jiang H, et al. Gut mycobiota alterations in patients with COVID-19 and H1N1 infections and their associations with clinical features. Commun Biol. 2021;4(1):480.
Moorthy A, Gaikwad R, Krishna S, et al. SARS-CoV-2, Uncontrolled diabetes and corticosteroids—an unholy trinity in invasive fungal infections of the maxillofacial region? a retrospective, multi-centric analysis. J Maxillofac Oral Surg. 2021;20(3):418-425.
Pettit NN, Nguyen CT, Mutlu GM. Late onset infectious complications and safety of tocilizumab in the management of COVID-19. J Med Virol. 2021;93(3):1459-1464.
Raut A, Huy NT. Rising incidence of mucormycosis in patients with COVID-19: another challenge for India amidst the second wave? Lancet Respir Med. 2021;9(8):E77.
Runwal P. A rare black fungus is infecting many of India’s Covid-19 patients – why? National Geographic. Published May 14, 2021. Accessed June 8, 2021. https://nationalgeographic.com/science/article/a-rare-black-fungus-is-infecting-many-of-india-covid 19-patients why
Singh AK, Singh R, Joshi SR, Misra A. Mucormycosis in COVID-19: a systematic review of cases reported worldwide and in India. Diabetes Metab Syndr. 2021;15(4):102146.
Song G, Liang G, Liu W. Fungal co-infections associated with global COVID-19 pandemic: a clinical and diagnostic perspective from China. Mycopathologia. 2020;185(4):599-606.
Verbic MD, Gruban J, Kos MK Incidence and control of steroid-induced hyperglycaemia in hospitalized patients at a tertiary care centre for lung diseases. Pharmacol Rep. 2021;73(3):796-805.

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