Assignment 2 ECUR 837

Mycosis, a serious fungal infection, is a life-threatening complication of COVID-19. It is caused by a mold that grows in damp environments such as soil and construction sites. The infection can spread through the air and hospitals, especially in humid environments. Immunosuppressed individuals, diabetics, organ transplant recipients, and those with comorbidities are at higher risk. Post-COVID patients treated with steroids are also at risk. The most common type of mycosis affects the oropharyngeal cavities, orbital tissues, and can extend to the brain. It was first noted in India and has now become a separate entity called COVID-associated mucormycosis (CAM). COVID-19 impairs the immune system, damages cells, and creates an acidic environment, which allows the fungus to grow. Hyperferritinemia and steroid use also contribute to the infection. The mortality rate of mycosis is high, even higher than COVID-19 itself. Physicians Hello and good morning everyone. This is Ayesha Irfan presenting my podcast on one of the life-threatening complications of COVID-19. We call mycosis, a serious fungal infection. This podcast is meant for third-year dental surgery students as part of their oral pathology curriculum. We call mycosis is an opportunistic fulminant infection caused by a seprobic mold growing in a damp environment, soil, and construction sites. It is also found in the air and hospitals, ICUs where contaminated oxygen cylinders and ventilator tubing in a humid hospital environment can further facilitate the spread of infection. Its pores can easily invade the respiratory tract and abated skin if standardized sterilization is not maintained. Although this is not a contagious disease, but immunosuppressed individuals, especially diabetics, organ transplants recipients, and patients with other comorbidities can easily get infected. Recently, post-COVID patients treated with steroids also emerged as a high-risk group of mucormycosis as an aftermath of uncontrolled diabetes mellitus precipitated by COVID-19. ROCM, one of its variants, Rhino-Occipital-Cerebral-Mucormycosis, is the most prevalent and often lethal type that tends to involve oropharyngeal cavities, orbital tissues, and can also extend to the brain. Other common clinical types of mucor are pulmonary, gastrointestinal, cutaneous, and disseminated infection. In 2020, its rise was first noted in India as an aftermath of COVID-19 and was declared an epidemic in two states of India by May 2021, and most of the infected cases were either active or recovered COVID-19 patients. Now, COVID-associated mucormycosis, CAM, has become a separate entity with reportedly 82% cases from India and 19% from rest of the world with a slight male predilection. According to studies, other South Asian countries including Pakistan and Bangladesh may also have a recent surge in CAM due to similar socio-economic status. The question is how this fungal infection is linked with COVID-19. The possible role of COVID-19 in the pathogenesis of mucormycosis is explained by different researches. According to scientists, SARS-CoV-2 opens the ground for opportunistic infections by impairing the cell-mediated immunity. It also induces the endothelial and alveolar cell damage facilitating the spread of mucoranes by providing the port of entry to its pores. Further virus-induced alveolar cell damage leads to hypoperfusion and lactic acidosis creating an acidic environment favorable for the fungus to grow. Also, the SARS-induced ACE-mediated pancreatic beta cell damage can cause acute diabetes-like state even in non-diabetic patients. Some of the studies also explore the possible role of hyperferritinemia in the pathogenesis of CAM. Depending on the severity of COVID-19, there is a concurrent increase in the serum ferritin level, an iodine-binding protein. It has been theorized that SARS-CoV-2 detaches the iodine from hemoglobin molecule increasing free iodine overload resulting in hyperferritinemia. The increased free iodine molecules induce cellular damage and provide food for the fungus to grow. Well, if this was not enough, the aggressive use of steroids for the management of cytokine storm in COVID-19 infection worsens the diabetes control and the immune system of the body making the fungus more invasive and lethal. These hormones not only suppress the immune cells but also increase insulin resistance. The overall mortality rate of mycormycosis is estimated to be 54% by the American Center for Disease Control and Prevention and it varies with the site of infection with almost 46% among people with ROCM which is far more than COVID-19 itself. To conclude, we can say that together COVID-19, steroid therapy, and uncontrolled diabetes make a favorable pride for the proliferation of this lethal fungus. The role of corticosteroids in the management of COVID-19 cannot be ignored but physicians should use evidence-based protocols in individual cases as according to WHO interim guidance of May 2020. The use of dexamethasone or other corticosteroids can be more harmful than beneficial in patients who do not require supplemental oxygen. The initial guidelines for the NIH from the NIH United Kingdom supported the use of six milligrams of dexamethasone once daily IV or by mouth for up to 10 days only to reduce the 28-day mortality rate. A multidisciplinary approach and vigorous management plan are required to manage such and prevent such fungal infection before any other pandemic appears. Thank you very much for today.