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 Table of Contents  
LETTER TO THE EDITOR
Year : 2021  |  Volume : 12  |  Issue : 3  |  Page : 381-382

Diabetes: The set stage for mucormycosis post COVID-19


1 Dr. N. T. R. University of Health Sciences, Vijayawada, Andhra Pradesh 520004, India
2 Dr. Pinnamaneni Siddhartha Institute of Medical Science and Research Foundation, Vijayawada, Andhra Pradesh, India
3 Mediciti Institute of Medical Sciences, Hyderabad, Telangana, India
4 Great Eastern Medical School and Hospital, Andhra Pradesh, India

Date of Submission03-Jun-2021
Date of Decision08-Jun-2021
Date of Acceptance10-Jun-2021
Date of Web Publication30-Sep-2021

Correspondence Address:
Mr. Tarun Kumar Suvvari
Dr. N. T. R. University of Health Sciences, Vijayawada, Andhra Pradesh.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JOD.JOD_70_21

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How to cite this article:
Suvvari TK, Arigapudi N, Garikipati NA, Boppana SH. Diabetes: The set stage for mucormycosis post COVID-19. J Diabetol 2021;12:381-2

How to cite this URL:
Suvvari TK, Arigapudi N, Garikipati NA, Boppana SH. Diabetes: The set stage for mucormycosis post COVID-19. J Diabetol [serial online] 2021 [cited 2021 Nov 30];12:381-2. Available from: https://www.journalofdiabetology.org/text.asp?2021/12/3/381/327314



Dear editor,

Mucormycosis, a name that is now familiar across the general public, is an invasive fungal infection of the maxillofacial region, usually affecting the immunocompromised; an abundance of which are provided by India’s large population of diabetics. This could explain the comparatively greater prevalence of the disease in India; in fact, in a report on the epidemiology of mucormycosis in India, it was stated that diabetes mellitus was reported in 54–76% of the cases annually.[1] As COVID-19 wreaked its havoc in India, it also brought in its wake an epidemic of mucormycosis. A simple way to explain the relationship of diabetes, mucormycosis, and COVID-19 would be by the Venn diagram [Figure 1], but alas, it is not that easy.
Figure 1: Venn diagram representing the relationship of diabetes, mucormycosis and COVID-19

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COVID-19 and diabetes in actuality have a bidirectional relationship: those who are diabetic have an increased risk of developing COVID-19, and those who are suffering from COVID-19 may have their diabetic status worsened; in fact, there have been many reports of euglycemic patients who have developed a “diabetic state.” The former association may be ascribed to diabetics reduced immunity, whereas the latter may be explained by steroid usage which increases blood glucose levels, damage to pancreatic islets induced by the SARS CoV, and insulin resistance due to excessive cytokine production.[2]

Mucormycosis comes into play when we add the factors of increased admissions and prolonged intensive care unit (ICU) stay, overcrowding of hospitals, and unhygienic usage of humidifiers, to the high number of COVID-19 cases and diabetics, of which again a large percentage is uncontrolled and on high doses of steroids. The increased blood glucose in these patients predisposes them for secondary bacterial or fungal infection; whereas the ICU, overcrowding, and unsterile humidifier usage provide an optimal environment for the Mucoromycetes to attack.[3]

The symptoms of mucormycosis include, but are not limited to, unilateral swelling of the face, headache, and nasal or sinus congestion; these may present as soon as 2 days following discharge and are often overlooked as regular post covid symptoms leading to a late admission and subsequently a poor prognosis.[2],[3] Hence, a multidisciplinary approach from a microbiologist, internal medicine specialist, ENT specialist, surgeon (maxillofacial/plastic), ophthalmologist, neurologist, intensivist, biochemist, and dentist was advised by the Indian Council of Medical Research (ICMR).

Considering all these points, can one correctly assume that to prevent the occurrence of this disease, a vigilant management of diabetic cases is enough? Or will the link of Covid 19 and mucormycosis persist and remain rampant even in the absence of a diabetic picture? These answers can be only told by adequate research, but it is impertinent to note that as of now, considering the indirect association, it would be foolish to not attempt to control this outbreak at the diabetic stage itself. Which then brings us to the question of “how?”

Considering the dictum “Prevention is better than cure,” vigilant monitoring of blood sugar levels is probably the first and best modality of control. Adequate monitoring of diabetic patients and making the necessary changes in their antidiabetic drug or insulin regimens to ensure control over the blood sugar levels, coupled with judicious usage of steroids, would help in creating an environment that is not so open to the invasion of mucormycosis. Monitoring, however, must not be confined to the hospital; as pointed out earlier, India boasts a high number of uncontrolled diabetics and one major reason for this is lack of self-/home-monitoring. As we enter the third decade of the 21st century, technological advancements have made easy and simple devices, whether hand-held or skin patches, to monitor blood glucose at home; promoting their usage would provide a great scope for curbing the number of uncontrolled and undiagnosed diabetics. Alongside monitoring, one cannot stress the importance of maintaining a healthy diet, regular exercise, and regular intake of medications in diabetics to sustain a healthy glucose level.[4] When such measures are practiced for a long run, we can strengthen our medical control over India’s major risk predisposed population and subsequently prevent diseases such as mucormycosis from progressing to an epidemic scale.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Prakash H, Chakrabarti A. Epidemiology of mucormycosis in India. Microorganisms 2021;9:523. https://doi.org/10.3390/ microorganisms9030523.  Back to cited text no. 1
    
2.
John TM, Jacob CN, Kontoyiannis DP. When uncontrolled diabetes mellitus and severe COVID-19 converge: The perfect storm for Mucormycosis. J Fungi 2021;7:298. https://doi.org/10.3390/jof7040298  Back to cited text no. 2
    
3.
Evidence based advisory in the time of COVID-19. Available at: https://www.icmr.gov.in/pdf/covid/techdoc/Mucormycosis_ADVISORY_FROM_ICMR_In_COVID19_time.pdf (last accessed on May 20, 2021).  Back to cited text no. 3
    
4.
Mohan V. Mucormycosis risk mitigation in the COVID battle. Available at: https://www.thehindu.com/opinion/op-ed/mucormycosis-risk-mitigation-in-the-covid-battle/article34552525.ece (last accessed on June 8, 2021).  Back to cited text no. 4
    


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