Mucormycosis co-infection in COVID-19 patients: An update

Abdullah S Alkhamiss; Ahmed A Ahmed; Zafar Rasheed; Ruqaih Alghsham; Ali Shariq; Thamir Alsaeed; Sami A Althwab; Suliman Alsagaby; Abdullah S M Aljohani; Fahad A Alhumaydhi; Sharifa K Alduraibi; Alaa K Alduraibi; Homaidan T Alhomaidan; Khaled S Allemailem; Raya A Alharbi; Samar A Alamro; Arwa M Alqusayer; Sahim A Alharbi; Thekra A Alharby; Mona S Almujaydil; Ayman M Mousa; Sultan A Alghaniam; Abdulrhman A Alghunaim; Rana Alghamdi; Nelson Fernández; Waleed Al Abdulmonem

doi:10.1515/biol-2022-0085

Mucormycosis co-infection in COVID-19 patients: An update

Open Life Sci. 2022 Aug 10;17(1):917-937. doi: 10.1515/biol-2022-0085. eCollection 2022.

Authors

Abdullah S Alkhamiss¹, Ahmed A Ahmed², Zafar Rasheed³, Ruqaih Alghsham¹, Ali Shariq⁴, Thamir Alsaeed¹, Sami A Althwab⁵, Suliman Alsagaby⁶, Abdullah S M Aljohani⁷, Fahad A Alhumaydhi⁸, Sharifa K Alduraibi⁹, Alaa K Alduraibi⁹, Homaidan T Alhomaidan¹⁰, Khaled S Allemailem⁸, Raya A Alharbi⁵, Samar A Alamro⁵, Arwa M Alqusayer⁵, Sahim A Alharbi⁵, Thekra A Alharby⁵, Mona S Almujaydil⁵, Ayman M Mousa^{11

12}, Sultan A Alghaniam¹³, Abdulrhman A Alghunaim¹⁴, Rana Alghamdi¹⁵, Nelson Fernández¹⁶, Waleed Al Abdulmonem¹

Affiliations

¹ Department of Pathology, College of Medicine, Qassim University, Buraidah, Saudi Arabia.
² Research Center, College of Medicine, Qassim University, Buraidah, Saudi Arabia.
³ Department of Medical Biochemistry, College of Medicine, Qassim University, Buraidah, Saudi Arabia.
⁴ Departments of Microbiology, College of Medicine, Qassim University, Buraidah, Saudi Arabia.
⁵ Department of Food Science and Human Nutrition, College of Agriculture and Veterinary Medicine, Qassim University, Buraidah, Saudi Arabia.
⁶ Department of Medical Laboratories Sciences, College of Applied Medical Sciences, Majmaah University, Majmaah, Saudi Arabia.
⁷ Department of Veterinary Medicine, College of Agricultural and Veterinary Medicine, Qassim University, Buraidah, Saudi Arabia.
⁸ Department of Medical Laboratories, College of Applied Medical Sciences, Qassim University, Buraidah, Saudi Arabia.
⁹ Department of Radiology, College of Medicine, Qassim University, Buraidah, Saudi Arabia.
¹⁰ Department of Family and Community Medicine, College of Medicine, Qassim University, Buraidah, Saudi Arabia.
¹¹ Department of Basic Health Sciences, College of Applied Medical Sciences, Qassim University, Buraidah, Saudi Arabia.
¹² Department of Histology and Cell Biology, Faculty of Medicine, Benha University, Benha, Egypt.
¹³ Department of Clinical Nutrition, Qassim Health Affairs, Ministry of Health, Buraidah, Saudi Arabia.
¹⁴ Private Health Sector, Qassim Health, Jeddah, Saudi Arabia.
¹⁵ Department of Chemistry, Science and Arts College, Rabigh Campus, King Abdulaziz University, Jeddah, Saudi Arabia.
¹⁶ School of Life Sciences, University of Essex, Colchester, UK.

Abstract

Mucormycosis (MCM) is a rare fungal disorder that has recently been increased in parallel with novel COVID-19 infection. MCM with COVID-19 is extremely lethal, particularly in immunocompromised individuals. The collection of available scientific information helps in the management of this co-infection, but still, the main question on COVID-19, whether it is occasional, participatory, concurrent, or coincidental needs to be addressed. Several case reports of these co-infections have been explained as causal associations, but the direct contribution in immunocompromised individuals remains to be explored completely. This review aims to provide an update that serves as a guide for the diagnosis and treatment of MCM patients' co-infection with COVID-19. The initial report has suggested that COVID-19 patients might be susceptible to developing invasive fungal infections by different species, including MCM as a co-infection. In spite of this, co-infection has been explored only in severe cases with common triangles: diabetes, diabetes ketoacidosis, and corticosteroids. Pathogenic mechanisms in the aggressiveness of MCM infection involves the reduction of phagocytic activity, attainable quantities of ferritin attributed with transferrin in diabetic ketoacidosis, and fungal heme oxygenase, which enhances iron absorption for its metabolism. Therefore, severe COVID-19 cases are associated with increased risk factors of invasive fungal co-infections. In addition, COVID-19 infection leads to reduction in cluster of differentiation, especially CD4+ and CD8+ T cell counts, which may be highly implicated in fungal co-infections. Thus, the progress in MCM management is dependent on a different strategy, including reduction or stopping of implicit predisposing factors, early intake of active antifungal drugs at appropriate doses, and complete elimination via surgical debridement of infected tissues.

Keywords: COVID-19; corticosteroids; diabetes: diabetes ketoacidosis; immunocompromise; mucormycosis; pulmonary; rhino-orbito-cerebral.

Publication types

Review