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      Are Low Serum Vitamin D Levels a Risk Factor for Advent of COVID-19 Associated Rhinocerebral Mucormycosis: A Preliminary Case Control Study

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          Abstract

          To determine whether low serum vitamin D level is a risk factor for development of Rhinocerebral mucormycosis in COVID-19 afflicted patients. A case control study was conducted in a tertiary care hospital utilizing the archived records of COVID-19 afflicted Rhinocerebral mucormycosis cases and age and gender matched controls. The mean value (± standard deviation) of vitamin D level in patients with Mucormycosis was 19.65 ± 13.07 ng/ml and in control subjects it was 27.88 ± 18.04 ng/ml.There was a significant difference between groups ( p = 0.02). Thus, low Vitamin D level may be implicated as a risk factor for the advent of mucormycosis in a COVID-19 afflicted patient and therefore Vitamin D supplements may be provided to such patients to achieve normal serum levels.

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          Mucormycosis in COVID-19: A systematic review of cases reported worldwide and in India

          Awadhesh Kumar Singh, Ritu Singh, Shashank R. Joshi … (2021)
          Background and aims There are increasing case reports of rhino-orbital mucormycosis in people with coronavirus disease 2019 (COVID-19), especially in India. Diabetes mellitus (DM) is an independent risk factor for both severe COVID-19 and mucormycosis. We aim to conduct a systematic review of literature to find out the patient's characteristics having mucormycosis and COVID-19. Methods We searched the electronic database of PubMed and Google Scholar from inception until May 13, 2021 using keywords. We retrieved all the granular details of case reports/series of patients with mucormycosis, and COVID-19 reported world-wide. Subsequently we analyzed the patient characteristics, associated comorbidities, location of mucormycosis, use of steroids and its outcome in people with COVID-19. Results Overall, 101 cases of mucormycosis in people with COVID-19 have been reported, of which 82 cases were from India and 19 from the rest of the world. Mucormycosis was predominantly seen in males (78.9%), both in people who were active (59.4%) or recovered (40.6%) from COVID-19. Pre-existing diabetes mellitus (DM) was present in 80% of cases, while concomitant diabetic ketoacidosis (DKA) was present in 14.9%. Corticosteroid intake for the treatment of COVID-19 was recorded in 76.3% of cases. Mucormycosis involving nose and sinuses (88.9%) was most common followed by rhino-orbital (56.7%). Mortality was noted in 30.7% of the cases. Conclusion An unholy trinity of diabetes, rampant use of corticosteroid in a background of COVID-19 appears to increase mucormycosis. All efforts should be made to maintain optimal glucose and only judicious use of corticosteroids in patients with COVID-19.
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            Novel perspectives on mucormycosis: pathophysiology, presentation, and management.

            Brad Spellberg, John Edwards, Ashraf Ibrahim (2005)
            Mucormycosis is a life-threatening fungal infection that occurs in immunocompromised patients. These infections are becoming increasingly common, yet survival remains very poor. A greater understanding of the pathogenesis of the disease may lead to future therapies. For example, it is now clear that iron metabolism plays a central role in regulating mucormycosis infections and that deferoxamine predisposes patients to mucormycosis by inappropriately supplying the fungus with iron. These findings raise the possibility that iron chelator therapy may be useful to treat the infection as long as the chelator does not inappropriately supply the fungus with iron. Recent data support the concept that high-dose liposomal amphotericin is the preferred monotherapy for mucormycosis. However, several novel therapeutic strategies are available. These options include combination therapy using lipid-based amphotericin with an echinocandin or with an azole (largely itraconazole or posaconazole) or with all three. The underlying principles of therapy for this disease remain rapid diagnosis, reversal of underlying predisposition, and urgent surgical debridement.
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              Epidemiology and clinical manifestations of mucormycosis.

              George Petrikkos, Anna Skiada, Olivier Lortholary … (2012)
              Mucormycosis is an emerging angioinvasive infection caused by the ubiquitous filamentous fungi of the Mucorales order of the class of Zygomycetes. Mucormycosis has emerged as the third most common invasive mycosis in order of importance after candidiasis and aspergillosis in patients with hematological and allogeneic stem cell transplantation. Mucormycosis also remains a threat in patients with diabetes mellitus in the Western world. Furthermore, this disease is increasingly recognized in recently developed countries, such as India, mainly in patients with uncontrolled diabetes or trauma. Epidemiological data on this type of mycosis are scant. Therefore, our ability to determine the burden of disease is limited. Based on anatomic localization, mucormycosis can be classified as one of 6 forms: (1) rhinocerebral, (2) pulmonary, (3) cutaneous, (4) gastrointestinal, (5) disseminated, and (6) uncommon presentations. The underlying conditions can influence clinical presentation and outcome. This review describes the emerging epidemiology and the clinical manifestations of mucormycosis.
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                Author and article information

                Contributors
                Ambika Gupta: drambika79@rediffmail.com
                Journal
                Journal ID (nlm-ta): Indian J Otolaryngol Head Neck Surg
                Journal ID (iso-abbrev): Indian J Otolaryngol Head Neck Surg
                Title: Indian Journal of Otolaryngology and Head & Neck Surgery
                Publisher: Springer India (New Delhi )
                ISSN (Print): 2231-3796
                ISSN (Electronic): 0973-7707
                Publication date (Electronic): 11 January 2022
                Pages: 1-5
                Affiliations
                [1 ]GRID grid.420149.a, ISNI 0000 0004 1768 1981, Department of Oral Medicine and Radiology, , Post Graduate Institute of Dental Sciences, ; Rohtak, Haryana India
                [2 ]GRID grid.420149.a, ISNI 0000 0004 1768 1981, Department of Oral and Maxillofacial Surgery, , Post Graduate Institute of Dental Sciences, ; Rohtak, Haryana India
                [3 ]GRID grid.420149.a, ISNI 0000 0004 1768 1981, Department of Public Health Dentistry, , Post Graduate Institute of Dental Sciences, ; Rohtak, Haryana India
                Article
                Publisher ID: 3080
                DOI: 10.1007/s12070-022-03080-7
                PMC ID: 8751664
                PubMed ID: 35036352
                SO-VID: 55df89f5-b580-4b2a-9683-8d51d25a824a
                Copyright © © Association of Otolaryngologists of India 2022
                License:

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

                History
                Date received : 17 December 2021
                Date accepted : 1 January 2022
                Categories
                Subject: Original Article

                Keywords: coronavirus disease (covid-19),mucormycosis,rhinocerebral mucormycosis,vitamin d(25-hydroxycholecalciferol)
                Data availability:
                Keywords: coronavirus disease (covid-19), mucormycosis, rhinocerebral mucormycosis, vitamin d(25-hydroxycholecalciferol)

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