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As the battle against the deadly Covid-19 pandemic is still continuing worldwide, several complications are being reported in patients who have recovered post-covid. One such lethal complication being reported in patients in India in recent times, who have tested positive for Covid-19 and are gradually recovering, is a fungal disease called Mucormycosis or the black fungus. With several hundreds of cases being reported all over the country, it has triggered an additional wave of panic among the general public. Post-Covid-19 patients who are more vulnerable to Mucormycosis are those with a history of poorly controlled diabetes mellitus and also those who are immuno-compromised and have been treated with steroids and other drugs for Covid-19. The aim of this short review is to briefly cover the epidemiology of mucormycosis, its possible pathophysiology in Post Covid scenario, the clinical presentation and its diagnosis and management.

Mucormycosis (also known as zygomycosis) is a dangerous but uncommon fungal infection caused by a fungus known as mucormycetes. Mucormycosis can be caused by a variety of fungi. Mucormycetes are fungi that belong to the Mucorales scientific order. Molds can be found all over the place. Mucormycosis is a fungal infection that primarily affects persons who have health issues or who use medications that reduce the body's capacity to resist infections and illness. After inhaling fungal spores from the air, it most usually affects the sinuses or lungs. The majority of people are unaffected by these fungus. Breathing in mucormycete spores, on the other hand, can induce an infection in the lungs or sinuses, which can spread to other regions of the body in patients with compromised immune systems. It can also happen as a result of a cut, a burn, or another sort of skin injury. The fatality rate varied based on the patient's underlying condition, the type of fungus, and the affected body part (for example, the mortality rate was 46 percent among people with sinus infections, 76 percent for pulmonary infections, and 96 percent for disseminated mucormycosis). Antifungal medicines such as amphotericin-B, isavuconazole, posaconazole, and various combinations are used to inhibit the growth. Mucormycosis was studied for its spread, symptoms, treatment, prevention, and consequences. Keywords: Mucormycosis, Black fungus, Posaconazole, Isavuconazole

Mucormycosis, formerly known as zygomycosis, is a potentially fatal invasive fungal disease (IFD) caused by fungi in the Mucorales order and the zygomycetes class. Mucormycosis is a rare but deadly fungal infection that generally affects those who have weakened immune systems. The infection has the potential to spread throughout the body. Death is a possibility with this type of severe infection. It’s important to get treatment. If left untreated, mucormycosis can be fatal. Zygomycosis has a high mortality of 70–100%. The prevalence of mucormycosis in India is approximately 80 times that of developed countries, with 0.14 cases per 1000 population. The main aim and purpose of this review related to overview and history, causative agents, epidemiology, etiopathogenesis, transmission, types, clinical features, recent advances in diagnosis and treatment of Mucormycosis. A systematic literature search was conducted in the electronic databases of PubMed, Google Scholar and relevant sources. It will be helpful for those who work in the medicine field to explore their knowledge about mucormycosis.

We describe two fatal cases of COVID-19 in which Rhizopus microsporus and Lichtheimia corymbifera were cultured from endotracheal aspirate samples. Both patients had no underlying comorbidities other than obesity. Despite antifungal therapy, both cases developed septic shock and progressive refractory hypoxemia without evidence of other underlying infections. It is unclear whether isolation of these fungal organisms represents invasive disease or corresponds to an epiphenomenon of critical illness. Yet, patients suffering from COVID-19 may be at risk of superinfection from a broader range of fungal organisms than previously thought.

There is a sudden surge of the cases of the black fungus infection ((mucormycosis / Zygomycosis), at a time when India is reeling under a catastrophe created by the second wave of Covid -19. it is like a 'medical tsunami, ' that ravaged the health care system and the administration alike, both being caught unaware. In the beginning, there is an acute shortage of hospital beds earmarked for this infection, and the lifesaving drug, the liposomal Amphotersin B, coupled with the appalling morbidity, mortality, not to speak of the financial burden and the resource crunch, that is inflicted by it.This article briefly reviews the black fungus infection in India, in the pre and post Covid -19 eras. The risk factors for the black fungus, both Covid associated (CAR) as well as non-Covid -19 associated, are discussed. The host as well as pathogen related factors, in the pathogenesis of the black fungus infection, are explored. An alternative explanation to diabetic ketoacidosis, (DKA) in providing the acidic pH required by the fungus, is hypothesized, as the occurrence of the infection, in the absence of DKA, remained inexplicable. It may be noted that the acidic pH is responsible for making available, the free iron from the host ‘s serum, that is needed for the sustenance, grouth and multiplication of the fungus, as well as causing phagocytic dysfunction in the host. The different clinical presentations of mucormycosis, their salient clinical features and the management are outlined in the present article.

The severe surge of coronavirus disease 2019 (COVID-19) cases on the Indian subcontinent in early 2021 was marked by an unusually high number of COVID-19–associated mucormycosis (CAM) cases reported during this same period. This is significantly higher than predicted based on available data about prevalence and risk factors for this condition. This may be due to an unusual alignment of multiple risk factors for this condition. There is high background prevalence of mucormycosis in India likely from a high prevalence of risk factors, including undiagnosed or poorly controlled diabetes. COVID-19–induced immune dysregulation and immune suppression from steroid therapy increase the risk. The role of environmental exposure is unclear. System factors such as lack of access to healthcare during a pandemic may result in delayed diagnosis or suboptimal management with potentially poor outcomes. Here, we review currently identified risk factors and pathogenesis of CAM in a pandemic surge.

Oral cavity is habitat for plethora of micro-organism causing various diseases. The most common includes dental caries, periodontal diseases, etc. Dental practice may rarely encounter unusual and subtle symptoms with nonpathognomonic clinical signs of several fatal diseases which may pretend like a common oral disease. Hence, the knowledge and clinical acumen of diagnostician are necessary for the early diagnosis of such fatal infections to prevent untoward consequences. Mucormycosis is an angioinvasive necrotic fungal infection with a high morbidity and mortality rate. It commonly occurs in patients with debilitating diseases and immunocompromised individuals. Clinically, it manifests as rhino-orbito-cerebral, pulmonary, cutaneous, gastrointestinal, renal, and disseminated form. Disease affecting the facial region is a challenge as it often disseminates with orbital and cranial involvement at the time of diagnosis. This article presents a case of mucormycosis which mimicked as severe periodontitis in a patient leading to delay in the diagnosis and challenges during the treatment.

Rhino cerebral orbital mucormycosis is an aggressively spreading fungal infection caused by filamentous fungi of the Mucoraceae family and is found to be more prone in patients with comorbidities that include: uncontrolled diabetes mellitus, immune-suppressed patients, iron and aluminum overload, chronic steroid therapy, severe trauma, and protein-energy malnutrition. A 51year old male patient was admitted to the hospital with a complaint of headache and intermittent fever. The patient had no history of diabetes or denovo hypertension. Based on the analysis of histopathological and radiological investigations, the patient was diagnosed with mucormycosis. The patient furthermore underwent an endoscopic surgical debridement followed by standard treatment including antifungal antibiotic(amphotericin-B) and azole antifungals (posaconazole) along with symptomatic treatment. Though the patient was given all possible therapy available, no improvement was seen in the patient's condition (poor prognosis).

This case report describes the progressive wound infection in the left thigh of a 34-year-old man due to an old landmine explosion. The infection developed into rapidly spreading skin and soft tissue necrotising Saksenaea infection, despite antifungal therapy and surgical debridement. The report provides evidence that Saksenaea spp. should be added to the list of mucoralean fungi that can cause severe necrotising infection. It also highlights the need for improved early diagnostic procedures and enhanced understanding of Saksenaea virulence factors that contribute to necrotising infection.

Background There are sparse data on the role of flexible bronchoscopy (FB) in diagnosing invasive mould infections (IMIs). Objective To investigate the safety and usefulness of FB in IMI. We evaluate the factors associated with a successful diagnosis of IMI using FB. Further, we compare subjects of invasive pulmonary aspergillosis (IPA) with pulmonary mucormycosis (PM). Methods We retrospectively reviewed the clinical features, imaging data, bronchoscopy, microbiology and pathology details of subjects who underwent FB for suspected IMI. We categorised FB as diagnostic if it contributed to the diagnosis of IMI. We performed a multivariate analysis to identify the factors associated with a diagnostic bronchoscopy. Results Of the 3521 FB performed over 18 months, 132 (3.7%) were done for suspected IMIs. We included 107 subjects for the final analysis. The risk factors for IMI included renal transplantation (29.0%), diabetes (27.1%), haematological malignancy (10.3%) and others. We found bronchoscopic abnormalities in 33 (30.8%) subjects, and these were more frequent in those with confirmed PM (67%) than IPA (27%). IMI was confirmed in 79 (14 proven, 48 probable and 17 possible) subjects. FB was diagnostic in 71%. We experienced major complications in three cases (2.7%), including one death. On multivariate analysis, the visualisation of endobronchial abnormalities during FB (OR [95%, CI], 8.5 [1.4-50.4]) was the only factor associated with a diagnostic FB after adjusting for age and various risk factors. Conclusions Flexible bronchoscopy is a useful and safe procedure in diagnosing IMIs. The presence of endobronchial abnormalities predicts a successful diagnostic yield on FB.

The fungal infection clinically referred as mycormycosis also zygomycosis are common infections to human where causative agent i.e., Mucoromycotina is member of mucorales. The causative agent mucoromycotina habitats in soil and decaying organic matter. The mycoromycotina infection remains associated with wide array of human disease including septic arthritis, dialysis-associated peritonitis, renal disorders, gastritis, and pulmonary diseases. These infections are closely associated with mucous layer of skin precisely cutaneous layer. These infections are also seen in clinical samples to nasal and upper respiratory tract. The higher prevalence of nasal cerebral i.e. rhinocerebral mycormycosis reported in case of immune compromised patients that trigger colonization of R. oryzae. In chronic state as infection reaches to lower respiratory tract these infection are difficult to diagnose and treat due to lack of precise methods. It has been reported neutropenia patients are more prone for mycormycosis infections due to extensive use of chemotherapy resulting impaired immunity. In recent time, necrotizing pneumonia is major symptoms reported in case of pulmonary mycormycosis. The common antifungal medication based clinical symptoms such as dyspnea, congestion and chest pain with rise in body temperature itraconozole is highly recommended. Further, a combination of antifungal and antimicrobial agents had shown a significant higher clinical recovery in mycormycosis case. Keywords: Amphotericin B, Hyponatremia, Itraconazole, Voriconazole, Oral Posaconazole.

Severe coronavirus disease (COVID-19) is currently managed with systemic glucocorticoids. Opportunistic fungal infections are of concern in such patients. While COVID-19 associated pulmonary aspergillosis is increasingly recognized, mucormycosis is rare. We describe a case of probable pulmonary mucormycosis in a 55-year-old man with diabetes, end-stage kidney disease, and COVID-19. The index case was diagnosed with pulmonary mucormycosis 21 days following admission for severe COVID-19. He received 5 g of liposomal amphotericin B and was discharged after 54 days from the hospital. We also performed a systematic review of the literature and identified seven additional cases of COVID-19 associated mucormycosis (CAM). Of the eight cases included in our review, diabetes mellitus was the most common risk factor. Three subjects had no risk factor other than glucocorticoids for COVID-19. Mucormycosis usually developed 10-14 days after hospitalization. All except the index case died. In two subjects, CAM was diagnosed postmortem. Mucormycosis is an uncommon but serious infection that complicates the course of severe COVID-19. Subjects with diabetes mellitus and multiple risk factors may be at a higher risk for developing mucormycosis. Concurrent glucocorticoid therapy probably heightens the risk of mucormycosis. A high index of suspicion and aggressive management is required to improve outcomes.

Background The body of evidence on cutaneous mucormycosis is largely derived from case reports or single-centre databases. Objectives Our study aimed to describe incidence, predisposing factors and inpatient outcomes of cutaneous mucormycosis in the United States. Methods We conducted a population-based retrospective study using the National Inpatient Sample 2016-17 data. Fifty-six discharges had a diagnosis of cutaneous mucormycosis on the International Classification of Diseases, tenth revision. Descriptive analysis was performed for the demographics, predisposing factors, length of stay (LOS), cost and inpatient mortality. The NIS represents 20% of all discharges in the United States, which allowed us to estimate the national incidence of cutaneous mucormycosis. Results An estimated total of 280 admissions occurred between 2016 and 2017, indicating 3.9 cases per million admissions across the United States. The estimated incidence rate was 0.43 cases per million people per year. Median age was 49.5 (19-59) years, 44.6% were female, and 54.9% were Caucasian. We identified haematologic malignancies (48.2%) and solid organ transplantations (10.7%), often accompanied by skin/soft tissue or post-procedural infections, were the most common predisposing conditions. Median LOS was 15 (6-31) days, median total charges were 187,030 (65,962-446,265) USD, and in-hospital mortality rate was 16.1%. Conclusions In current clinical practice, physicians may encounter cutaneous mucormycosis most commonly in severely immunocompromised hosts with haematologic malignancies or transplantations, accompanied by skin/soft tissue or post-procedural infections. A high index of suspicion and prompt tissue sampling in at-risk groups is important to improve the outcomes.

The novel coronavirus disease (COVID-19) quickly spread to all continents. However, data regarding all the signs and symptoms of COVID-19 are insufficient. Patients with COVID-19 might present higher susceptibility to fungal coinfections. Mucormycosis is a rare and often life-threatening fungal disease characterized by vascular invasion by hyphae, resulting in thrombosis and necrosis. This is the first case report of mucormycosis in a COVID-19 patient. An 86-year-old male patient was admitted to the emergency room with acute diarrhea, cough, dyspnea, and fever from 5 days prior. Blood tests revealed a hemoglobin level of 14.3 mg/dL. Five days following the admission, the patient presented with melena and a hemoglobin level of 5.6 mg/dL. A transfusion of three units of red blood cells was required. Esophagogastroduodenoscopy revealed two giant gastric ulcers with necrotic debris and a deep hemorrhagic base without active bleeding. Furthermore, biopsies confirmed mucormycosis. Despite intensive care, the patient died 36 hours after the esophagogastroduodenoscopy.

Highlights • Colon Obstruction Due to Gastrointestinal Basidiobolomycosis is extremely rare. • A fungal vascular invasion with tumor affecting multiple organ may present a challenging clinical situation. • Early surgical resection remains the treatment of choice and plays a potentially curative role., Introduction Gastrointestinal basidiobolomycosis (GIB) is an uncommon fungal infection caused byBasidiobolus ranarum, with less than 80 cases reported in the literature. Presentation of case A 36-year-old woman presented with colicky upper abdominal pain for 2 months and inability to pass stool for 2 days. Computed tomography of the abdomen and colonoscopy both showed a mass in the transverse colon. Colonoscopic biopsy suggested a zygomycosis. Laparotomy revealed a perforated mass in the transverse colon; the mass also involved the small bowel and stomach. En bloc resection was performed, and the incision was closed for a second-look procedure. The patient was admitted to the intensive care unit and placed on a ventilator and inotropes; however, her condition deteriorated, and she died on day 24 post admission. The histopathology report (obtained after the patient’s death) was consistent with GIB. Discussion Gastrointestinal basidiobolomycosis presents with nonspecific signs and symptoms and so the diagnosis is easily missed or delayed. Timely, accurate diagnosis is crucially important, especially when there is intestinal obstruction and sepsis. Persistent severe abdominal pain in a patient with neutropenia should alert the physician to the possibility of a fungal infection. There are reports from several countries of basidiobolomycosis in immunocompetent hosts. The disease shows no age predilection, but males may be more susceptible. Treatment is with surgical debridement and antifungal drugs—ideally the lipid formulation of amphotericin B. Conclusion Gastrointestinal basidiobolomycosis is a rare infection that can be fatal if not diagnosed and treated early.

Background Rhinofacial entomophthoramycosis is a specific fungal infection of the skin and subcutaneous tissue. It is considered as a rare and neglected disease in tropical and subtropical areas. We would like to present our cases to aid other physicians in the improved recognition of typical cases. Materials and methods A retrospective review was performed on patients with the diagnosis of Conidiobolomycosis or Entomophthoramycosis in Chiang Mai University Hospital, Thailand, from January 2009 to May 2019. There were seven cases with a definite pathologic report or culture in this review. Results All seven patients were men and were referred to the university hospital for diagnosis. The mean age was 53 ± 15.7, ranging from 27 to 71 years. Most of the patients (85.7%) presented first with nasal or rhinofacial swelling and nasal obstruction. The definite diagnosis came from clinical presentation and investigation with a tissue biopsy, culture and communication among physicians. Patients responded well with a combination of medical treatment, including potassium iodide (KI), co-trimoxazole, or itraconazole. Conclusion Rhinofacial entomophthoromycosis or Conidiobolomycosis typically can be diagnosed under a suspicious clinical presentation. The obvious clinical response can be seen within several weeks after medication., Highlights • Rhinofacial entomophthoramycosis or Conidiobolomycosis is uncommon disease, but commonly presented with facial swelling. • Typical clinical presentations were demonstrated to help other physicians in the improved recognition and diagnosis. • This is a disease that once known, will not be forgotten.

A 7‐year‐old castrated male French Bulldog was examined for chronic large intestinal enteropathy. A colonic mass and thickened rectal mucosa were identified, and histopathologic examination of endoscopic biopsy specimens disclosed eosinophilic proctitis with large (5‐20 μm), irregularly shaped, pauciseptate hyphae that were Gomori methenamine silver and periodic acid‐Schiff positive. Amplification and sequencing of ribosomal DNA extracted from paraffin‐embedded tissues yielded a sequence with 97% identity to GenBank sequences for Basidiobolus ranarum. After itraconazole, terbinafine, and prednisone administration, clinical signs resolved rapidly, and sonographic lesions were largely absent after 6 weeks. Treatment was discontinued by the owner 15 weeks after diagnosis. Three weeks later, the dog collapsed acutely and was euthanized. Necropsy identified metastatic islet cell carcinoma and grossly unremarkable colorectal tissues. However, histopathology of the rectum disclosed multifocal submucosal granulomas with intralesional hyphae morphologically similar to those previously observed. This report is the first to describe medical treatment of gastrointestinal basidiobolomycosis in a dog.

Highlights • Mucormycosis is a rare disease and is often fatal in the immunocompromised. • We present a series of 3 patients with poorly controlled diabetes and mucormycosis. • Diagnosing mucormycosis requires microbiologic and microscopic evidence. • Combined medical and surgical management yields better outcomes for mucormycosis., Introduction Mucormycosis is a rare, aggressive, and invasive disease with a fatal outcome. It most commonly affects patients with compromised immunity, particularly those with poorly controlled diabetes. We present a case series of patients with uncontrolled diabetes and mucormycosis. Presentation of case We present a series of three patients with uncontrolled diabetes, with main symptoms of paranasal sinusitis, nasal discharge, ophthalmic changes, and facial nerve involvement. Diagnoses of mucormycosis were made via microbiological testing and computed tomography. These cases were managed by combination therapy of tight glycemic control, urgent endoscopic sinus debridement, and antifungal therapy. Discussion Diagnosing rhino-orbito-cerebral mucormycosis requires a high degree of suspicion and both microbiologic and microscopic evidence. Better clinical outcomes can be obtained by combining medical and surgical management. Conclusion We describe our experience in handling three cases of poorly controlled diabetes with rhino-orbito-cerebral mucormycosis.

Mucormycosis is a rare and severe invasive fungal infection caused by ubiquitous fungi of the order Mucorales. Infection often occurs in immunocompromised hosts and includes cutaneous, pulmonary, gastrointestinal, rhinocerebral, and disseminated forms of disease. Although the clinical characteristics of mucormycosis are well established, infection can be difficult to diagnose antemortem, resulting in frequent postmortem diagnoses. Despite this, the gross appearance of mucormycosis at autopsy has not been well described. In the present report we illustrate the gross and histologic findings in four autopsy cases of mucormycosis, including one case of pulmonary disease and three cases of disseminated mucormycosis with cerebral, pulmonary, hepatic, renal, and gastrointestinal involvement. In all cases autopsy examination demonstrated characteristic hemorrhagic infarcts with a targetoid appearance in the affected organs. These findings are secondary to fungal angioinvasion with subsequent thrombosis and tissue necrosis. Mucormycosis should be suspected at autopsy when these characteristic infarcts are identified within the proper clinical context, and a high suspicion for atypical infections should be maintained postmortem in immunosuppressed patients.

Patients with hematological malignancies and allogeneic hematopoietic stem-cell transplant recipients carry a high risk of rare (non-Aspergillus molds and non-Candida yeasts) invasive fungal infections (IFI). We retrospectively evaluated and described the patient profile, clinical manifestations, isolated species, treatment and outcome of patients with hematological malignancies diagnosed with these rare IFIs during 15 years in a large single hemato-oncology center. Eighty-seven patients with hematological malignancies treated in our center had at least one positive culture or molecular identification of a rare fungus. Ninety-three isolates were considered the etiological agents of the infection. The most common underlying hematological malignancy was acute myeloid leukemia, 36 patients (41.4%). Eighty patients (91%) received chemotherapy less than 30 days prior to IFI diagnosis. The most frequent site of infection was the respiratory tract: 34 patients (39%) had pulmonary and 19 patients (22%) had a sinusal or nasopharyngeal infections. Disseminated infection, defined as positive blood cultures or parallel infection in multiple organ systems, was documented in 20 patients (23%). The most common fungal species were Fusarium (35%) and Zygomycetes (25%). Coinfection with more than one fungus was noted in 20 patients (23%). Forty-seven of 87 patients (54%) in this study died within 90 days of IFI diagnosis. Rare IFIs in patients with hematological malignancy become increasingly frequent. Early identification with traditional and molecular methods is important in management of these patients.

Background: Mucormycosis is a worldwide angio-invasive fungal infection that is associated with high morbidity and mortality. A few European studies have focused on the epidemiology. Methodology: A retrospective longitudinal descriptive study was performed with inpatients diagnosed with mucormycosis (ICD-9-CM, code 117.7, cases 1997-2015; and ICD-10, code B46, cases 2016-2018; along with length of hospital stay) in Spanish public hospitals between 1 January 1997 and 31 December 2018. Data were obtained from the Minimum Basic Data Set (CMBD in Spanish). Principal findings: A total of 962 patients were recorded; 665 were men. The mean age (±SD) was 55±18.8 years. The annual incidence rate increased from 0.74 to 1.24 cases per million person-years. The lethality rate was 31.3%. Renal failure (41.6%) and hematological malignancy (36.3%) were the main factors involved. Conclusions: Mucormycosis is a rare infectious disease in Spain, but it has had a significantly increased incidence in the last two decades. Being an adult male and having diabetes, neoplasm or renal failure are the main factors associated. High mortality is usually associated mainly with hematological malignancy and renal failure. CMBD studies could be an efficient tool for assessing changes in the epidemiology of mucormycosis.

Background The enormous increase in COVID-19-associated mucormycosis (CAM) in India lacks an explanation. Zinc supplementation during COVID-19 management is speculated as a contributor to mucormycosis. We conducted an experimental and clinical study to explore the association of zinc and mucormycosis. Methods We inoculated pure isolates of Rhizopus arrhizus obtained from subjects with CAM on dichloran rose Bengal chloramphenicol (DRBC) agar enriched with (three different concentrations) and without zinc. At 24 hours, we counted the viable colonies and measured the dry weight of colonies at 24, 48, and 72 hours. We also compared the clinical features and serum zinc levels in 29 CAM cases and 28 COVID-19 subjects without mucormycosis (controls). Results We tested eight isolates of R.arrhizus and noted a visible increase in growth in zinc-enriched media. A viable count percentage showed a significantly increased growth in four of the eight isolates in zinc-augmented DRBC agar. A time- and concentration-dependent increase in the mean fungal biomass with zinc was observed in all three isolates tested. We enrolled 29 cases of CAM and 28 controls. The mean serum zinc concentration was below the reference range in all the subjects and was not significantly different between the cases and controls. Conclusions Half of the R.arrhizus isolates grew better with zinc enrichment in vitro. However, our study does not conclusively support the hypothesis that zinc supplementation contributed to the pathogenesis of mucormycosis. More data, both in-vitro and in-vivo, may resolve the role of zinc in the pathogenesis of CAM.

In the case of hospitalized COVID-19 patients, especially aging people and those with severe symptoms who require a ventilator, corticosteroids are given in an attempt to alleviate some of the symptoms. However, steroids are known to lower immunity and raise blood sugar levels, and they tend to increase clotting factors and fibrinogen concentrations in patients. This situation provides an opportunity for pathogens to evade the human immune system and infect the host. According to a recent study, the number of cases of mucormycosis (also known as zygomycosis, black fungus) have increased in COVID-19 patients who are either hospitalized or have recovered [1] . Mucormycosis affects the nose, eyes, and brain [2] and is a potentially fatal intrusive fungal infection that frequently affects immunodeficient individuals. People with type-2 diabetes with blood sugar levels higher than 220 mg/dL, autoimmune disorders, iatrogenic immunosuppression, or hematological cancers, and organ transplant recipients are especially vulnerable to mucormycosis [3] . Mucormycosis invades sinus tissues within 3 to 4 weeks [4] , and rhinocerebral mucormycosis can manifest with unusual signs and symptoms comparable to severe sinusitis, such as nasal blockage, crusting, proptosis, facial oedema, ptosis, chemosis, ophthalmoplegia, in addition to headache, fever, and other neurological symptoms [5] . Black eschar is common in the nasal cavity or over the hard palate region and penetration of blood vessels, vasculitis with thrombosis, tissue infarction, haemorrhage, and acute neutrophilic infiltrates are histopathological characteristics [6] . Without early identification and treatment, the condition may proceed rapidly, with reported fatality rates from intra-orbital and cerebral complications of 50–80%. Even with quick diagnosis, treatment of underlying conditions, and vigorous medical and surgical interventions, therapy is frequently non-effective, resulting in spread and eventual death [7] . There are several hypotheses as to what else may contribute to mucormycosis infections. Some are unlikely, such as the use of industrial oxygen or ventilation systems, age-related immune complications and non-sterile water, whilst others believe that steam inhalation may play a role by impacting the mucosa, in addition to zinc supplementation being a fungal growth promoter [8] .

We report a case of a 57-year-old Vietnamese gentleman who presented with chest pain and shortness of breath for four weeks. The patient had a history of diabetes mellitus and kidney transplant in the past year and was currently on immunosuppressive agents. The patient's condition worsened despite broad-spectrum antibiotics, so amphotericin was added. Further evaluation with bronchoscopy and transbronchial biopsy was suggestive of Rhizopus mucormycosis. Despite antifungal therapy, his condition worsened, resulting in multi-organ failure and eventual mortality.

The catastrophic phase of Covid-19 turns the table over with the spread of its disastrous transmission network throughout the world. Covid-19 associated with mucormycosis fungal infection accompanied by opportunistic comorbidities have emerged the myriad of complications and manifestations. We searched the electronic databases of Google Scholar, PubMed, Springer, and Elsevier until June 05, 2021, using keywords. We retrieved the details of confirmed and suspected mucormycosis patients associated with Covid-19. We analyzed the case reports, treatment given for Covid-19, steroids used, associated comorbidities, mucormycosis site involved, and patients survived or dead. Overall, 102 patients of mucormycosis associated with Covid-19 have been reported from India. Mucormycosis was predominant in males (69.6%) rather than females (19.6%), and most of the patients were active Covid-19 cases (70.5%). Steroids were mostly used (68.6%) for the treatment of Covid-19 followed by remdesivir (10.7%). Patients were suffering from diabetes mellitus (88.2%) and severe diabetic ketoacidosis (11.7%). Mucormycosis affects the sino-nasal (72.5%), orbit (24.5%), central nervous system (18.6%), and maxillary necrosis (13.7%) of the patients. The Mortality rate was recorded as 23.5%, and recovery rate was 2.9%. Diabetes mellitus cases are highest in India as compared to other countries, and prevalent use of steroids with the background of Covid-19 becomes an opportunistic environment for mucormycosis fungal infection to survive.

Entomophthoromycosis is a rare fungal infection of the skin and subcutaneous tissue occurring predominantly in tropical and subtropical regions. In children, it mostly affects the lower half of the body. With this, we report a case of Entomophthoromycosis in a 6-year-old girl who presented late with extensive involvement of the upper half of the body. She responded well to treatment with potassium iodide and itraconazole. We also reviewed cases of Entomophthoromycosis reported in children.

Mucormycosis is an infection caused by one of several types of mold. Invasive mucormycosis is the most aggressive, rapidly progressive fungal infection. The disease is characterized by high attributable mortality. The early and accurate diagnosis of invasive mucormycosis determines the choice of an adequate therapeutic policy, by improving the prognosis of the disease. The method of choice for diagnosing pulmonary mucormycosis is computed tomography that allows accurate determination of the location and extent of the lesion, the state of the lung parenchyma, and the presence of concomitant complications. The paper describes a clinical case of damage to the lung and skin in invasive mucormycosis in a 28-year-old woman with aplastic anemia. The case is of interest due to a larger number of immunocompromised patients, especially those susceptible to the disease.

Mucormycosis is a rare but potentially mortal opportunistic infection caused by Mucorales. We present a case of rhinoorbital mucormycosis in an 11-year old male with neuroblastoma successfully treated with aggressive surgical debridement and antifungal combination of liposomal amphotericin B and posaconazole. Our patient developed signs of paranasal sinus infection and culture of fine needle biopsy grew Rhizopus arrhizus. Prompt treatment and drastic surgical resection led to complete clinical and radiological recovery without evidence of mucormycosis relapse. Keywords: Mucormycosis, Zygomycosis, Mucorales, Pediatric oncology, Paranasal sinuses

Mucormycosis is a severe infection that affects a variety of patients, including immunocompromised children and neonates. Given improved survival rates from advances in the treatment of malignancies, the population at risk for mucormycosis is increasing. We conducted a systematic review of cases of mucormycosis in children in the English-language literature reported between August 2008 and June 2017 and analyzed the clinical characteristics, diagnosis, management, and outcome of those infections. The most common underlying diagnoses included neutropenia (41%), hematologic malignancy (39%), prematurity (13%), and hematopoietic stem cell transplant (11%). Sinus disease (28%) and disseminated disease (24%) were the most common presentations. Rhizopus spp were the most common organisms isolated (22%). Amphotericin B remains the backbone of treatment and was prescribed in 86% of these cases. The resulting mortality rate remains high (32%). We provide here the results of a literature review of mucormycosis in children, including its epidemiology and clinical manifestations, and describe current advances in its diagnosis and treatment.

BACKGROUND Posaconazole (PCZ) is used mainly for the prevention of invasive fungal infection (IFI). METHODS A multicentre retrospective, investigational study using a non-randomized, single-arm design carried out in six tertiary hospitals in Spain to evaluate the use of PCZ in different forms of administration in the (non-prophylactic) treatment of IFI. RESULTS Over an eight-year-period, 67 patients were included in this study. PCZ was administered as salvage therapy (intolerant or refractory to a previous antifungal agent) in 65/67 (97%); of these, it was used against Aspergillosis (68.6%), Zygomycosis (13.4%), other moulds (8.9%) and yeast (10.5%). The median duration of PCZ therapy was 75 days. The oral solution was associated with low serum levels (

Fungi of the basal lineage order Mucorales are able to cause infections in animals and humans. Mucormycosis is a well-known, life-threatening disease especially in patients with a compromised immune system. The rate of mortality and morbidity caused by mucormycosis has increased rapidly during the last decades, especially in developing countries. The systematic, phylogenetic, and epidemiological distributions of mucoralean fungi are addressed in relation to infection in immunocompromised patients. The review highlights the current achievements in (i) diagnostics and management of mucormycosis, (ii) the study of the interaction of Mucorales with cells of the innate immune system, (iii) the assessment of the virulence of Mucorales in vertebrate and invertebrate infection models, and (iv) the determination of virulence factors that are key players in the infection process, for example, high-affinity iron permease (FTR1), spore coat protein (CotH), alkaline Rhizopus protease enzyme (ARP), ADP-ribosylation factor (ARF), dihydrolipoyl dehydrogenase, calcineurin (CaN), serine and aspartate proteases (SAPs). The present mini-review attempts to increase the awareness of these difficult-to-manage fungal infections and to encourage research in the detection of ligands and receptors as potential diagnostic parameters and drug targets.

Introduction Mucormycosis is a rare systemic fungal infection seen in immune-compromised patients. Gastrointestinal tract involvement is not usual. Case presentation A 36 years female presented with fever and progressive bilateral leg swelling for 25 days. She was diagnosed as nephrotic syndrome and started on methylprednisolone and cyclophosphamide. She developed hematochezia during hospital stay. On colonoscopy, ulcero-proliferative lesion was noted in caecum. Histopathology examination has confirmed it as mucormycosis of Caecum. Discussion Mucormycosis is an opportunistic angioinvasive disease caused by fungus zygomycosis it is a rare disease and often manifests as a life-threatening condition in immune-compromised patient. Invasion by fungal hyphae leads to arterial thrombosis, tissue infarction, hemorrhage and, necrosis. Diagnosis is confirmed by histopathological examination and culture. It is usually treated by the anti-fungal drug- liposomal amphotericin and surgical debridement. Conclusion Mucormycosis is a fatal systemic fungal infection, which can present as lower gastrointestinal bleeding in immunocompromised patients.