INTRODUCTION:

Throughout the history of Mucormycosis, from the first case in humans reported in 1885 by Paltauf, through publication by Gregory et al of the first observation of rhino-orbital cerebral Mucormycosis in 1943, to the report by Harris in 1955 of the first known survivor, little has changed in the diagnosis and outcome of this disease. Mucormycosis or zygomycosis is a rare but serious opportunistic fungal infection caused by a group of molds called mucormycetes³.

These fungi live throughout the environment, particularly in soil and in decaying organic matter, such as leaves, compost piles, or rotten wood. These organisms are omnipresent in nature and can be found on decaying vegetation and in the soil. These fungi proliferate and release large numbers of spores that can become airborne¹.

Risk factors includes:

· Diabetes mellitus particularly with ketoacidosis

· Malnutrition

· Malignancies (lymphomas and leukemias)

· Renal failure

· Organ transplant

· Burns

· Immunosuppressive therapy

· Cirrhosis, and AIDS

· Treatment with deferoxamine

Classification of Mucormycosis⁵:

Types		Route of transmission		Clinical features		Vulnerable people
Rhinocerebral (sinus and brain) Mucormycosis		Inhalation of spores into the paranasal sinuses and the invasion of blood vessels in the tissue		Nasal congestion or discharge, though it may progress to facial numbness, blurry vision, nasal discharge, nasofrontal headache, ocular pain, fever, diplopia, and chemosis.		Uncontrolled diabetes, patients with renal transplant
Pulmonary (lung) Mucormycosis		Inhalation of infectious material		Fever, hemoptysis, dyspnea, and cough		People with cancer organ transplant or a stem cell transplant
Gastrointestinal Mucormycosis	The ingestion of contaminated food/ herbal medicine		Nausea, vomiting, ulceration, and thrombosis of the gastric, esophageal and intestinal mucosa, manifested by diarrhea, hematemesis, and melena		Young children than adults, especially premature and low birth weight infants less than 1 month of age, who have had antibiotics, surgery, or medications
Cutaneous (skin) Mucormycosis	Skin infection by direct inoculation and in secondary form, by dissemination from other locations.		Abscesses, skin swelling, and necrosis		Burns and traumatic skin wounds
Disseminated Mucormycosis	Blood stream		Not specified		Neutropenic patients with hematologic malignancies, post transplants or in patients on deferoxamine therapy

Diagnosis:

· Medical History

· Physical Examination

· Histological evaluation of Mucormycosis is the mainstay of diagnosis

· CT scan

Treatment:

The standard management of Mucormycosis requires early diagnosis, a reversal of risk factors and underlying illness, surgical debridement, and prompt administration of intravenous antifungals. Amphotericin B is considered first-line therapy for Mucormycosis⁶. The lipid formulation of amphotericin B is administered in high doses intravenously once a day as initial therapy. The initial starting dose is 5mg/kg IV daily, with a maximum dose of 10mg/kg IV. Posaconazole or Isavuconazole has some evidence as second-line therapy in Mucormycosis. For salvage treatment, Posaconazole 200mg IV four times daily is recommended. The guidelines do not support the combination of amphotericin and posaconazole. Other adjuncts include hyperbaric oxygen. The increased oxygen pressure improves the ability of neutrophils to kill the organism and facilitates wound healing. Surgical debridement of infected tissue should be urgently performed to limit the further spread of infection. Aggressive surgical debridement of necrotic tissue should take place immediately. This may involve radical facial resections, partial pneumonectomy, colectomy, etc., in accordance with the site of disease. Similar to necrotizing fasciitis, this requires very aggressive surgical management and often carried dramatic morbidity. The prompt management of hyperglycemia, acidosis, and cessation of immunosuppressive agents when possible².

Possible reason for high incidence rate of Mucormycosis in Covid- 19 patients:

· Improper use of oxygen cylinders with contaminated mask and water,

· Improper oral and nasal care of patients during Covid in hospital.

· Excessive use of corticosteroids drugs.

· Improper control of diabetes

· Negligence of patient/relatives during post recovery period

· Exposure to soil, dust.

· Contaminated food ingestion.

· Use of contaminated mask or improper cleaning.

· Lack of proper follow up from both side hospital and patient.

· Deficient knowledge regarding complications or precautions to be taken.

CONCLUSION:

An extensive systematic literature search was conducted to locate articles related to the research question. The research is done by meta-analysis of various research done and articles published. Moreover, it is found that excessive use of corticosteroids drugs suppress the immunity and cause increase in blood glucose which makes patient prone to Mucormycosis. Further research is required to understand the exact pathophysiology of this rare fungal infection. The utmost important is to ensure that it should not become a new common hospital associated infection.

REFERENCES:

1. https://www.ncbi.nlm.nih.gov/books/NBK544364/

2. https://pubmed.ncbi.nlm.nih.gov

3. Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Foodborne, Waterborne, and Environmental Diseases (DFWED)

4. Roden MM, Zaoutis TE, Buchanan WL, Knudsen TA, Sarkisova TA, Schaufele RL, et al. Epidemiology and outcome of zygomycosis: a review of 929 reported cases external icon. Clin Infect Dis. 2005 Sep 1;41(5):634-53.

5. Petrikkos G, Skiada A, Lortholary O, Roilides E, Walsh TJ, Kontoyiannis DP. Epidemiology and clinical manifestations of Mucormycosis external icon. Clin Infect Dis. 2012 Feb;54 Suppl 1: S23-34.

6. Walsh TJ, Gamaletsou MN, McGinnis MR, Hayden RT, Kontoyiannis DP. Early clinical and laboratory diagnosis of invasive pulmonary, extrapulmonary, and disseminated Mucormycosis (zygomycosis) external icon. Clin Infect Dis. 2012 Feb;54 Suppl 1:S55-60.

Received on 27.05.2021 Modified on 01.08.2021

Asian J. Nursing Education and Research. 2021; 11(4):599-600.

DOI: 10.52711/2349-2996.2021.00139

Neha Abhishek Sharma

ABSTRACT:

INTRODUCTION:

Risk factors includes:

Classification of Mucormycosis⁵:

Treatment:

Possible reason for high incidence rate of Mucormycosis in Covid- 19 patients:

CONCLUSION:

REFERENCES:

Neha Abhishek Sharma

ABSTRACT:

INTRODUCTION:

Risk factors includes:

Classification of Mucormycosis5:

Treatment:

Possible reason for high incidence rate of Mucormycosis in Covid- 19 patients:

CONCLUSION:

REFERENCES:

Classification of Mucormycosis⁵: