COVID - 19 Presenting with Fungal Infections - The Hidden Pandemic within Pandemic?

Abstract

As the pandemic continues to spread vigorously, it is being noted that the COVID 19 virus is associated with various complications during the disease and also a great deal of post disease sequel.1 These gruelling complications are integrated with the overwhelming infection caused by the cytokine storm produced by the virus. While the treatment modalities are still under trial, glucocorticoids seem to have played a pivotal role in putting a check to the inflammation caused by the virus and have forbidden the organ damage caused thereafter. However, the aftermath of glucocorticoids usage has its own benefits and risks. Glucocorticoids cause cellular immunodeficiency and thus have immunosuppressive effects, additionally the use of immunomodulators such as tocilizumab alters the immune system and it subsequently predisposes the host to various secondary opportunistic infective agents. In the current state, as the pandemic abstains from fading away, an increasing trend of secondary fungal infections has been seen with COVID-19, resulting in an outbreak of fungal infections such as mucormycosis and candidiasis. Mucormycosis refers to any infection caused by the fungi of the Order Mucorales. Mucormycosis has been documented in the literature to be associated with a high rate of mortality due to its potential to spread drastically.2 Altered immunity is an important risk factor for mucormycosis. Additionally, diabetes has been noted to be critical for the development of mucormycosis in immunocompetent patients. Candidiasis is an infection caused by the candida species due to the immunosuppressed state developed by the use of glucocorticoids, which results in secondary fungal infection requiring urgent medical attention. The objective of this case report is to highlight the impending secondary fungal infection outbreak in COVID-19 and the need to contain this emerging spread of fungal infections under the blanket of this deadly pandemic.