Coronavirus disease 2019-associated mucormycosis – A syndemic

Coronavirus disease 2019 (COVID-19) and COVID-associated mucormycosis (CAM) came as a syndemic that not only severely increased morbidity and mortality but also posed a serious challenge for the healthcare system of a developing country like India. Although mucormycosis is a rare disease with a worldwide incidence of 0.43 cases per million population/year, these two COVID-19 waves caused a total of more than 14,000 cases in India itself. Mucormycosis is an angio-invasive fungal infection with rapid progression. The three major modalities of treatment involve early surgical debridement, initiation of antifungal therapy and controlling the predisposing risk factor. A complex interplay of factors, including pre-existing disease such as diabetes mellitus, use of immunosuppressants and immunomodulators, risk of hospital-acquired infection and immune dysregulation post-COVID-19, may all predispose to the development of CAM. Future research regarding the efficiency of newer antifungal with lower side effect profiles and evidence-based establishment of risk factors for adopting preventing strategies is the need of the hour. The disease is known to have high mortality despite the best treatment. We review in this article the aetiopathogenesis, various diagnostic modalities and treatment considerations for this disease.