Mucormycosis, an invasive fungal infection, has shown a surge in incidence over the years, which may be due to an increase in the number of diabetics, malignancy patients, and use of immunosuppressants. Mucormycosis presents in numerous clinical forms, like rhino-orbito-cerebral, pulmonary, gastrointestinal, and cutaneous. 

Mucorales are thermotolerant and ubiquitous, that grows on organic substrates like bread, decaying fruits and vegetables, crop debris in soil, compost, and animal excreta. 

During this second wave of the COVID-19 pandemic, cases of mucormycosis surged in relatively less time, due to associated comorbidity of diabetes mellitus, expanded usage of higher doses and prolonged span of systemic corticosteroids, the glucogenic and prothrombotic propensity of the virus, hypoxic environment, COVID pneumonia, increased hospitalization, ICU admissions, and mechanical ventilation. Its commonest presentation in COVID-19 remains rhin-orbito-cerebral form. 

The main species causing mucormycosis is Rhizopus oryzae, which has hyaline, sparsely-septate, broad, ribbon-like hyphae with irregular right-angle branching ribbon-like hyphae with rhizoids. This infection can be diagnosed early with a 10% KOH mount. Since this fungus shows a very rapid rate of growth, it can be differentiated from its main ally, Aspergillus. 

The treatment utilizes extensive surgical debridement and liposomal amphotericin B. The second line of treatment includes Posaconazole and isavuconazole, which can also be used for maintenance. Control of diabetes and COVID-19, and judicious use of antibiotics and systemic corticosteroids, are important management strategies that could be utilized in these pandemic times.

Source- Vasudevan B, Hazra N, Shijith K P, Neema S, Vendhan S. Mucormycosis: The Scathing Invader. Indian J Dermatol 2021;66:393-400