Emerging Threat of Mucormycosis in the COVID-19 Era: A Review of Epidemiology, Risk Factors, and Therapeutic Strategies

Abstract

Mucormycosis is a rare but very aggressive invasive fungal infection that has emerged as a major opportunistic infection during the COVID-19 pandemic, particularly in immunocompromised patients. The term “black fungus” is used for a group of fungi known as Mucorales such as Rhizopus, Mucor, Lichtheimia, and Apophysomyces species. Uncontrolled diabetes mellitus, extensive use of corticosteroids, lengthy intensive care unit (ICU) stay, and exposure to contaminated medicine, including oxygen delivery systems, were largely blamed for the sudden surge in cases, especially in India. There is rapid angioinvasion in mucormycosis, causing vascular thrombosis and necrosis, which can result in high mortality when diagnosis and treatment is delayed. The clinical manifestations are rhino-orbito-cerebral, pulmonary, cutaneous, gastrointestinal, and disseminated mucormycosis. A high degree of clinical suspicion with imaging studies, histopathological examination, and advanced molecular studies like polymerase chain reaction and internal transcribed spacer sequencing are necessary for accurate diagnosis. Management strategies emphasize early initiation of antifungal therapy, most commonly liposomal amphotericin B, posaconazole, or isavuconazole, alongside aggressive surgical debridement when indicated. In recent clinical trials, isavuconazole is highly effective and less toxic compared to other azoles. This review highlights the significance of a multidisciplinary approach, increased awareness among high-risk groups, and continued epidemiological monitoring for future outbreaks. Continuous efforts are required to improve the diagnostic capacity and preparedness for public health in order to lower the burden of mucormycosis in the world.