Unholy trinity: Diabetes, rampant use of steroids amid Covid appear to increase mucormycosis, says experts

THE UNHOLY trinity of diabetes, rampant use of corticosteroid along with Covid-19 appears to increase the occurrence of mucormycosis, a rare Black Fungus infection, experts said.

All efforts should be made to maintain optimal glucose besides judicious use of corti-costeroids in patients with Covid-19, a new study, published in Diabetes And Metabolic Syndrome, Clinical Research and Review Journal has said.

Dr Shashank Joshi, among the key authors of the study and an expert member of the state Covid-19 task force, said diabetes mellitus (DM) is an independent risk factor for both severe Covid-19 and mucormycosis and the study aimed to conduct a systematic review of literature to find out the characteristics of a patient with mucormycosis and Covid-19.

Authors Awadhesh Kumar Singh, Anoop Misra and others searched the electronic database of PubMed and Google Scholar since the pandemic’s inception until May 13, 2021.

“We retrieved all the granular details of case reports/series of patients with mucormycosis and Covid-19 reported worldwide. Subsequently, we analysed the patients’ characteristics, associated comorbidities, location of mucormycosis, use of steroids and its outcome in people with Covid-19,” the authors said.

Overall, 101 cases of mucormycosis in Covid patients were studied. Of these, 82 were from India and 19 from the rest of the world. Mucormycosis was predominantly seen in males (78.9 percent), both in people, who were active (59.4 percent) or recovered (40.6 percent) from Covid-19.

Pre-existing diabetes mellitus (DM) was present in 80 percent of cases, while concomitant diabetic ketoacidosis (DKA) was present in 14.9 percent.

Corticosteroid in-take for the treatment of Covid-19 was recorded in 76.3 percent of cases. Mucormycosis involving nose and sinuses (88.9 percent) was the most common followed by rhino-orbital (56.7 percent).

Mortality was noted in 30.7 percent of the cases. Globally, the prevalence of mucormycosis varied from 0.005 to 1.7 per million population, while its prevalence is nearly 80 times higher (0.14 per 1,000) in India compared to developed countries, as per a recent estimate of 2019–2020.

India has the highest cases of the mucormycosis in the world. The country already has the second largest population with diabetes mellitus (DM) and was the diabetes capital of the world. DM has been the most common risk factor linked with mucormycosis in India. It remains the leading risk factor associated with mucormycosis globally, with an overall mortality of 46 percent according to the study report.