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| LETTER TO THE EDITOR |
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| Year : 2021 | Volume
: 11
| Issue : 2 | Page : 60-61 |
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Mucormycosis and diabetes: Lessons from the COVID pandemic
Dewark Sharma1, Bhaskar Borgohain2, Bishwajit Saikia3
1 MRM Memorial Hospital, Kokrajhar, Assam, India
2 Department of Orthopedics, North Eastern Indira Gandhi Regional Institute of Health & Medical Sciences (NEIGRIHMS), Shillong, Meghalaya, India
3 Department of Anatomy, North Eastern Indira Gandhi Regional Institute of Health & Medical Sciences (NEIGRIHMS), Shillong, Meghalaya, India
| Date of Submission | 23-Jul-2021 |
| Date of Acceptance | 27-Jul-2021 |
| Date of Web Publication | 05-Oct-2021 |
Correspondence Address:
Dr. Dewark Sharma
MRM Memorial Hospital, Kokrajhar 783370, Assam
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/2278-8239.327552
How to cite this article:
Sharma D, Borgohain B, Saikia B. Mucormycosis and diabetes: Lessons from the COVID pandemic. Assam J Intern Med 2021;11:60-1 |
Dear Editor,
Mucormycosis, an angioinvasive multisystem fungal infection, has emerged as an important complication of coronavirus disease-2019 (COVID-19) disease and treatment. Many cases have emerged all over the world where COVID-19-positive patients have developed mucormycosis. From the limited data that we have, diabetes mellitus has emerged as the most important risk factor.[1] With the advent of multiple vaccines, humanity is hopeful of tiding over the COVID-19 pandemic, but the pandemic of diabetes is not going anywhere anytime soon. Hence, it is important to be vigilant so that we may be able to control future outbreaks of mucormycosis and such other infections.
A careful analysis of the epidemiological data of mucormycosis and diabetes is a pointer toward their close relationship. The global prevalence of the former varies, but the prevalence in India has been found to be 0.14 cases per 1000 population, which is about 80 times that in developed countries.[2] Despite the relatively small numbers, it is noteworthy that the prevalence of the disease shows a rising trend both globally and in India.[2] In contrast to mucormycosis, diabetes is a much more widespread problem. The International Diabetes Federation estimates the global prevalence of diabetes to be 9.3% and projects that it may increase to 10.9% by 2045.[3] India is one of the global hubs of diabetes, holding roughly 77 million persons with diabetes, a number which is projected to rise to 134 million people by 2045.[3] The striking similarity here is the continuing increase in India of the prevalence of both diabetes and mucormycosis. Interestingly, some studies have pointed out that the rise in the prevalence of former may be responsible for the rise in the prevalence of the later.[4]
COVID-19 pandemic has had multiple glycemic implications. Known cases of diabetes have presented with worsened blood glucose and previously euglycemic persons have developed new-onset diabetes.[5] Just like diabetes, cases of mucormycosis have also been increasing during the pandemic. A web-based meta-analysis found that 94% of new-onset mucormycosis in COVID-19 patients had diabetes.[6] The same study also found that 71% of reported mucormycosis cases in COVID-19 patients were from India![6]
Although mucormycosis can affect multiple organs, the disease in patients of COVID-19 has been seen to be of rhino-orbital or rhino-cerebral variety, which is consistent with the clinical presentation of the disease in diabetes mellitus.[7] This also points to the strong link of the disease to diabetes.
A noteworthy aspect of the link between mucormycosis and diabetes is the use of corticosteroids to treat COVID-19. Despite limited evidence, these drugs have been widely (and probably indiscriminately) used during the pandemic.[6] Corticosteroids have a dual role in the development of mucormycosis. They impair the immune response and they worsen the glycemic status.[6]
The pandemic has restressed the well-known strategies for prevention of mucormycosis––control of blood glucose and judicious use of steroids. The chronic relationship between rising trend of diabetes and mucormycosis probably means that we may be able to control the later by if we can bring down the prevalence of the former.
Various studies have successfully showed that lifestyle intervention and medications can prevent or delay the development of type 2 diabetes.[8] An increased public awareness and possible administrative interventions regarding adoption of a healthier lifestyle are the need of the hour if the menace of mucormycosis is to be controlled. Such measures need to be adopted at the grassroot level. It is also important to make persons with diabetes aware about the danger of mucormycosis so that they may make an informed decision to keep their blood glucose under control. The use of steroids needs to be rationalized both in persons with and without diabetes. Regular screening for new-onset diabetes is important for people who are on long-term steroid therapy. Persons with diabetes may also require steroids for frequent musculoskeletal complications like adhesive capsulitis and flexor tenosynovitis; it should be ensured that such use is rational and occasional.
If mucormycosis is the weed, diabetes is the root and steroids are the fertilizers. Striking at the root and cutting off the supply of the fertilizers is essential; otherwise, the weed will become a forest and annihilate our ecosystem.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Ravani SA, Agrawal GA, Leuva PA, Modi PH, Amin KD. Rise of the phoenix: Mucormycosis in COVID-19 times. Indian J Ophthalmol 2021;69:1563-8.  [Full text] |
| 2. | Skiada , et al. Epidemiology and diagnosis of mucormycosis: An update. J Fungi (Basel) 2020;6:265. |
| 3. | Saeedi P, Petersohn I, Salpea P, Malanda B, Karuranga S, Unwin N, et al; IDF Diabetes Atlas Committee. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the international diabetes federation diabetes atlas, 9 th edition. Diabetes Res Clin Pract 2019;157:107843. |
| 4. | Chakrabarti A, Singh R. The emerging epidemiology of mould infections in developing countries. Curr Opin Infect Dis 2011;24:521-6. |
| 5. | Misra A, Ghosh A, Gupta R. Heterogeneity in presentation of hyperglycaemia during COVID-19 pandemic: A proposed classification. Diabetes Metab Syndr 2021;15:403-6. |
| 6. | Misra A. Majorly resurgent and uncontrolled diabetes during COVID19 era, and in the future can be contained in India. Diabetes Metab Syndr2021. doi: 10.1016/j.dsx.2021.05.015. [Epub ahead of print]. |
| 7. | John TM, Jacob CN, Kontoyiannis DP. When uncontrolled diabetes mellitus and severe COVID-19 converge: The perfect storm for mucormycosis. J Fungi (Basel)2021;7:298. |
| 8. | Crandall JP, Knowler WC, Kahn SE, Marrero D, Florez JC, Bray GA, et al; Diabetes Prevention Program Research Group. The prevention of type 2 diabetes. Nat Clin Pract Endocrinol Metab 2008;4:382-93. |
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