Mucormycosis cases have greatly risen in India with the second wave of COVID-19 cases. Normally being harmless to an immunocompetent host, this infection can prove deadly in patients with an impaired immune system. This group may include individuals with hematological malignancies, poorly controlled diabetes, receiving steroids or other immunosuppressant. 

It is a rapidly developing infection with angioinvasive infection, demonstrating rhino–orbital–cerebral and pulmonary manifestations as the most common forms of the disease. 

India observes more cases of mucormycosis than other parts of the world, with the pre-pandemic infection estimates to be 70 times higher than the global average.

The factors that would have led to the sudden surge in the mucormycosis cases during the pandemic wave may be attributed to widespread use/ misuse of steroids, poorly controlled diabetes, and mucosal damage from the virus. Additionally, factors related to the host, pathogen (heightened prevalence and virulence of Mucorales strains in India), or the antecedent SARS-CoV-2 infection (with an increased risk imposed by variants predominating in India [ie, the Delta variant]) are hypothesized to be other contributing factors.

Due to the chronic neglect in the research in this field, the medical profession has been left with a scarcity of tools to diagnose and treat mucormycosis. Prompt diagnosis remains crucial as it checks the rapid progression of the infection. However, the Diagnosis is based on histology and tissue culture, which further are invasive, slow, and insensitive. Diagnostic tools like serology tests or serum biomarkers are unavailable for mucormycosis diagnosis, which hampers early diagnosis. 

Once a diagnosis is established, the management too is challenging, as it demands surgical debridement of infected and necrotic tissue, which can lead to visual loss and/or severe disfigurement. Another hindrance on the way is the cost of effective antifungal therapy, which remains unaffordable for many.

This mucormycosis epidemic in India has made us rethink the seriousness of fungal infections and must focus on the science on their prevention, diagnosis, and management. 

Source:  Stone N, Gupta N, Schwartz I. Mucormycosis: time to address this deadly fungal infection. The Lancet,2021;2(8):E343-E344

DOI:https://doi.org/10.1016/S2666-5247(21)00148-8