Muscat – Oman reported the first three cases of the fatal fungal infection mucormycosis – commonly known as black fungus – on June 15, 2021. A recently published study in International Journal of Infectious Diseases by Omani researchers reported that ten cases were diagnosed in the sultanate in the month of June in 2021. Of these, six died.

All patients were known to have poorly controlled diabetes mellitus or newly diagnosed with the condition.

A surge in COVID-19 associated mucormycosis cases were observed during the second wave of COVID-19 in the summer of 2021. The majority of cases were reported from India. The Delta variant (B.1.617.2) was the most common variant circulating at the time.

Mucormycosis, which is an angio-invasive fungal infection with high morbidity and mortality, proved to be deadly in the sultanate too, the study titled ‘COVID-19 Associated Mucormycosis: Opportunistic Fugal Infection. A case study and review,’ found.

‘We present ten cases of COVID-19 associated rhino orbital and rhino orbital cerebral mucormycosis managed in a secondary hospital in Oman. The median time for developing mucormycosis was two weeks from the COVID-19 diagnosis,’ the study said.

‘Five patients received corticosteroid therapy for COVID-19. Three patients had severe COVID-19 infection and died due to severe Acute Respiratory Distress Syndrome (ARDS) and septic shock. Three other patients died with advanced rhino orbital cerebral mucormycosis. Despite aggressive medical and surgical intervention, the mortality rate was 60 per cent.’
Those who died had poor blood sugar control and four of them had severe diabetic ketoacidosis.

The study concluded that mucormycosis is an aggressive opportunistic infection with high morbidity and mortality that requires prompt recognition and urgent intervention.

‘Uncontrolled blood sugar, the use of corticosteroids and immune dysfunction in COVID19 patients all are important risk factors for development of mucormycosis. Worse outcomes are associated with poor glycemic control despite aggressive medical and surgical interventions.’

Out of the ten, eight patients were Omanis and two Indians. There were three female and seven male patients aged 16 to 67 years (median age 44.5 years).

Seven out of the ten patients presented to the emergency department with three to seven days’ history of headache, and periorbital pain (ten days to three weeks from COVID-19 illness, except one patient who presented within three days of COVID-19 illness).

Clinical presentation included periorbital swelling, chemosis and ophthalmoplegia on examination. All seven patients had mild COVID-19 illness but two of them received one dose of dexamethasone prior to admission from another institution.

The three other patients were admitted for severe COVID-19 pneumonia/ARDS one to four weeks prior to diagnosis of mucormycosis. All three patients received a high dose dexamethasone (8mg once daily) for the duration of hospital stay despite having poor glycemic control.