Endocrine Abstracts

During the second wave of COVID-19 pandemic in some parts of the world especially in India there were significant numbers of rhino-orbital mucormycosis cases were reported. These cases were remarkably found in COVID-19 patients with diabetes, new-onset diabetes, DKA, stress hyperglycaemia, high ferritin levels, concomitant corticosteroid therapy defective phagocytic activity due to diabetes itself or immunosuppressive agents. COVID-19 is witnessed with widespread manifestations of opportunistic bacterial, fungal and parasitic infections. The mucorales spores germinate in hyperglycaemic, hypoxic and acidic environment that usually found in prolonged hospitalised patients with or without mechanical ventilation. Rhino-orbital mucormycosis is an angioinvasive disease caused by mold fungi of the genus Rhizopus, Mucor, Rhizomucor, Cunninghamella and Absidia of Order Mucorales being in class of Zygomycetes. The Rhizopus Oryzae is most common type and responsible for nearly 60% of mucormycosis cases in humans and also accounts for 90% of the Rhino-orbital-cerebral mucormycosis, and especially during this COVID-19 pandemic with an overall 46% mortality. In a large meta-analysis of 851 cases done in 2018, found diabetes remains the leading risk factor of mucormycosis (Odds ratio [OR] 2.69; 95% Confidence Interval [CI] 1.77–3.54; P < 0.001). After the landmark RECOVERY trial of UK, there are a trend of wide-spread use of steroid in more or less every cases of COVID-19 but surprisingly the emergence of mucormycosis was unheard in UK and elsewhere but in India. Even before the pandemic the sporadic incidences of mucormycosis were reported in India. In a recent case series of 101 mucormycosis cases in Covid-19, where 80% cases had diabetes, and more than two-third (76.3%) received a course of corticosteroids. These findings suggest a trinity of mucormycosis, diabetes and injudicious use of steroid, in people with COVID-19. Correction of risk factors, surgical debridement and a course of Amphotericin B are the main line of treatment.