A Comprehensive Review on the Management of COVID-19-Associated Mucormycosis (CAM): The New Basics

Abstract

The outbreak of coronavirus disease (COVID-19), which comes with several comorbidities, was declared a pandemic in early 2020 by World Health Organization (WHO). Glucocorticoids that are used in severe cases of COVID-19 as therapeutic measures may lead to opportunistic fungal infections in such patients. Mucormycosis is one of these infections and mostly occurs in immune-compromised patients such as those who undergo transplant surgeries. However, it rarely develops in COVID-19 patients, although many cases of COVID-19-associated mucormycosis (CAM) have been found in developing nations, like India. CAM usually develops between 15 days to a few months after hospitalization or complete recovery from coronavirus disease. It is an uncommon yet serious infection that further agitates the severe symptoms of COVID-19 disease. Patients with diabetes mellitus and other comorbidities are likely to be at a higher risk for developing mucormycosis. Concurrent glucocorticoid therapy possibly heightens the risk as it increases blood glucose levels. Dentists, as frontline healthcare workers, maybe the first to be presented with oral manifestations and therefore need to pay special attention. In light of the available pieces of evidence, this review highlights the basics of the underlying condition starting from the pathology, causative factors, and clinical manifestations, including the oral cavity, to diagnosis, treatment, and prevention of mucormycosis with both conventional and advanced approaches. We limited this study to the basic and established methods of CAM management and treatment along with the statistical updates. Other antifungal drugs and novel microbiological peptides are in development and need future studies for their elucidation.