Mucormycosis during COVID-19

Mucormycosis (also referred to as zygomycosis) is a serious invasive infection, caused by a group of molds called mucormycetes, or simply mucorales. Though it is a rare disease, being increasingly recognized in immunocompromised patients, the COVID-19 pandemic has been the reason for mucormycosis turning into an epidemic in India.

Treatment of COVID-19 patients with corticosteroids enhances the blood sugar levels, added to it weakened immunity of the COVID-19 patients, and exposure to unhygienic ambient enhanced the prevalence of mucormycosis-infected patients.

Starting with a minor skin infection, mucormycosis can develop within any part of your body. Though not contagious, one can get infected by mucoromysis fungus through inhalation, inoculation, or ingestion of the fungal spores. It can also spread through bandages, linen, unsterilized water, poor air filtration, non-sterile instruments, and open wounds.

The past of mucormycosis and its major types
The term mucormycosis is derived from mucor (moldy) + mycosis (fungal infection). Kurchenmeister described the first case of lung mucormycosis in 1855. Furbringer described pulmonary mucormycosis for the first time in 1876, caused by Lichtheimia. Platauf coined the term mycosis mucorin a in 1885. Gregory, et al., did the first observation of rhino-orbital cerebral mucormycosis in 1943. Harris reported about the first known survivor of mucormycosis in 1955. CDC mentions at least five key types of mucormycosis, rhinocerebral (sinus and brain), pulmonary (lung), gastrointestinal, cutaneous (skin) and disseminated (bloodstream) mucormycosis.

Mucormycosis sample collection
During the second wave of COVID-19 in India, the need for an ideal fungal transport medium was intensified due to massive increase in mucormycosis patients in India. HiMedia, with its five decades of core expertise in making microbial transport media, worked extensively on this and developed a unique formulation of HiFungalTM Transport Medium w/swab; MS5478 (FTM) along with nylon flocked stick.

Isolation of mucormycosis fungi
Considering the many challenges of isolating the selective fungi to expidite the exact line of therapy for patients through anti-fungal profiling, HiMedia has developed two distinct selective and rapid growth-supporting media in ready-prepared media format for isolation of filamentous fungi (mucormycosis selective agar; MP5476) and non-filamentous fungi such as yeasts (candida selective agar; MP5477) from specimens collected from mucormycosis patients. These media are designed respectively for selective growth of filamentous fungi (black and yellow fungi) and candida species (white fungi) from samples collected from mucormycosis patients. The best part of these newly developed media is the mucormycosis fungi grow and sporulate rapidly, within 18 to 36 hours, as tested in-house, using fresh clinical isolates of mucormycosis fungi. The pure fungal cultures so obtained, can be used further for detailed taxonomy studies and antifungal profiling to decide the exact line of antifungal therapy. They can also be further used for identification through microscopy, macroscopy, MALDI-TOF, and by internal transcribed spacer (ITS) method.

Advantages of FTM and these two selective media have been synergized by combining them together in the form of a single kit. The kit MUCO-diagno^TM (K144) is a complete one-stop easy solution for clinicians to isolate causative fungi from mucormycosis patients. It is a pioneering kit, one-of-its-kind in the Indian market.

Mucormycosis – What more is required?
In view of high mortality rate of mucormycosis, prompt diagnosis, recovery from the predisposing factors, early intervention with surgical debridement, and therapeutic drugs are the only hopes to pull through. The sudden upsurge in COVID-19-associated mucormycosis patients has highlighted the lacuna in antifungal therapy, and opened doors for the quest for novel potent antifungal scaffolds, having activity at par or more than amphotericin B. It also opened doors to look for alternative sustained-release drug delivery systems for the safe delivery of toxic antifungals. It being a nosocomial infection, more powerful and potent fumigants and surface disinfectants are needed to curb such infections.