INTRODUCTION:

Mucormycosis is a fungal illness that affects the skin. It’s a rare occurrence, but it’s also quite dangerous. It usually happens when immunity is reduced as a result of a sickness like Covid-19. R. D. Baker, an American pathologist, invented the term mucormycosis¹. ¹Mucormycosis is a fungal infection caused by fungus in the Mucorales order. Zygomycosis is another name for it. It is classified as rhinocerebral, cutaneous, and disseminated, gastrointestinal or pulmonary. Rhizopus oryzae is the most prevalent organism recovered from mucormycosis patients, accounting for 70 percent of all mucormycosis cases.

Mucormycosis is an aggressive, life-threatening infection that affects persons with a weakened immune system (immune-compromised), such as people with uncontrolled diabetes mellitus or low neutrophil counts (a type of white blood cell). Persons whose immune systems are inhibited by pharmaceuticals (immunosuppression) as part of their therapy for blood cancer (haematological malignancy), hematopoietic stem cell transplantation, or solid-organ transplantation, or people whose immune systems are suppressed by medications (neutropenia).²Patients with diabetes mellitus are more likely to develop rhino-cerebral mucormycosis, while patients with haematological malignancies are more likely to develop pulmonary mucormycosis. Mucormycosis causes a destructive and urgent condition in diabetes individuals due to a weakened immune response and an increase in accessible nutrients. Mucorales can enter a susceptible host through inhalation, contaminated food consumption, or abraded skin. Infections of the rhino-orbito-cerebral, pulmonary, gastrointestinal, or cutaneous/wound system result from these routes.³ Monocyte and neutrophil counts and function are major mucormycosis risk variables since they are known to limit Mucorales spore germination. Patients with haematological diseases, AIDS, or liver cirrhosis, as well as individuals who have had a solid organ transplant or are on high-dose steroids, fall into this category.⁴

Mucormycosis is a fungal infection caused by mucormyete moulds. These organisms can be found in:

· Stacks of compost

· Soil

· Wood that has rotted

Mucormycosis is very harmful since it swiftly spreads throughout the body. The infection can spread to the lungs or the brain if left untreated. This can result in a brain infection as well as paralysis.^5-6

· Pneumonia

· Seizures

· Death

Risk factors:^7-8

· Low birthweight and prematurity (for neonatal gastrointestinal mucormycosis)

· Diabetes, especially diabetic ketoacidosis, is a serious condition.

· Cancer

· Transplantation of organs

· Transplantation of stem cells

· Neutropenia is a condition in which the body’s (low number of white blood cells)

· Use of corticosteroids for a long time

· Use of injectable drugs

· In the body, there is too much iron (iron overload or hemochromatosis)

Symptoms of Mucormycosis:^9,10

· Nasal obstruction.

· The nose bleeds or discharges.

· Inside the mouth, there are black fungal spots.

· Eyeballs that are swollen.

· The ability to move the eyeballs is lost.

· Double vision is a common occurrence.

· Redness and pain in the eyes.

· Blindness.

Synthetic treatment for Mucormycosis:

· Amphotericin B (given through an IV)

· Posaconazole (given through an IV or orally)

· Isavuconazole (given through an IV or orally)

Ayurvedic treatment for Mucormycosis:¹¹

1. Eat Yoghurt and Probiotics: Some types of yogurt contain probiotics, which may boost digestive health by reducing the symptoms of common gastrointestinal disorders, such as bloating, diarrhoea and constipation.

2. Wash the affected area with Soap and Water: This will control the spread of infection.

3. Use Apple Cider Vinegar: It has antifungal properties, hence we can use this remedies.

4. Use Coconut Oil: Coconut oil has antibacterial activity, antiviral, antifungal, antiprotozoal, and also can enhance the immune system.

5. Use Tea Tree Oil: The chemicals in tea tree oil may kill bacteria and fungus, and reduce allergic skin reactions.

6. Use Garlic: Garlic is one of the most potent antifungal and antimicrobial herbs. Those who eat garlic regularly are less susceptible to fungal infections. Crush a couple of garlic with some olive oil and make a paste.

7. Use Turmeric: Mucormycosis primarily affects people who have health problems hence we can take turmeric. It contains curcumin which is also good for our health.

8. Consuming foods rich in Vitamin C

Steps to Prevent Mucormycosis: ⁽¹²⁾

· Wear a mask to avoid inhaling fungal spores.

· Avoid damp places where fungi grow and flourish.

· Wear gloves while gardening to avoid contact with soil and manure.

· Take precautions to avoid cuts and grazes.

· Maintain overall cleanliness around patients.

· Any oral ulcer should be treated immediately.

Clinical diagnosis:

Variable T1 and T2 intensity with focused lack of enhancement in areas of devitalized sinus mucosa may be seen on magnetic resonance imaging (MRI). Contrast-enhanced computed tomography (CT) scans of the cavernous sinus may indicate a lack of enhancement in this area, which is consistent with thrombosis caused by the invasive fungus.¹³ Other radiographic observations of mucormycosis include a rim of soft tissue thickness along the paranasal sinuses, opacification of the sinuses, fluid levels in the sinuses, and bone degradation. Mucormycosis might be difficult to distinguish from other sinoorbital disorders due to the general nature of these symptoms. Once mucormycosis has been diagnosed, CT and MRI scans can be used to determine the extent of the illness and guide surgical debridement.^14,15

Do’s

· Control hyperglycemia

· Monitor blood glucose level post covid discharge and in diabetes

· Use steroid judiciously

· Use clear, sterile water for humidifiers during oxygen therapy

· Use antibiotics

Don’ts

· Don’t miss warning signs and symptoms

· Don’t consider all cases of blocked nose as cases of bacterial sinusitis, especially in cases of immunosupression and covid patients on immunodulators.

· Don’t hesitate in seeking aggressive investigations as appropriate for detecting fungal etiology

· Don’t lose crucial time to initiate treatment for mucormycosis

Transmission of mucormycosis:^16,17

· It is not contagious and does not spread by contact of person to person.

· fungus is found in the environment.

· Transmission occurs through inhalation, inoculation, or ingestion of spores from the environment.

· Although most cases are sporadic, healthcare-associated outbreaks have been linked to adhesive bandages, wooden tongue depressors, hospital linens, negative pressure rooms, water leaks, poor air filtration, non-sterile medical devices, and building construction.

· It most commonly affects the sinuses or the lungs after inhaling fungal spores from the air. In such cases, it may spread to brain and eyes.

· It may also occur on the skin after a cut, burn, or other type of skin injury gets infected.

CONCLUSION:

Mucorales are naturally resistant to the majority of antifungal medications. We utilise a combination of Synthetic and Ayurvedic treatments to treat Mucormycosis. In patients with COVID-19, all attempts should be taken to maintain appropriate glucose levels, with only moderate use of corticosteroids.⁽¹⁸⁾

REFERENCE:

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Received on 22.07.2021 Modified on 06.08.2021

Asian J. Res. Pharm. Sci. 2021; 11(4):316-318.

DOI: 10.52711/2231-5659.2021.00049