TY - JOUR
T1 - The Pathogenetic Dilemma of Post-COVID-19 Mucormycosis in India
AU - Chakrabarti, Sankha Shubhra
AU - Kaur, Upinder
AU - Aggarwal, Sushil Kumar
AU - Kanakan, Ahalya
AU - Saini, Adesh
AU - Agrawal, Bimal Kumar
AU - Jin, Kunlin
AU - Chakrabarti, Sasanka
N1 - Publisher Copyright:
© 2021 Chakrabart SS. et al.
PY - 2022/2/1
Y1 - 2022/2/1
N2 - There has been a surge of mucormycosis cases in India in the wake of the second wave of COVID19 with more than 40000 cases reported. Mucormycosis in patients of COVID-19 in India is at variance to other countries where Aspergillus, Pneumocystis, and Candida have been reported to be the major secondary fungal pathogens. We discuss the probable causes of the mucormycosis epidemic in India. Whereas dysglycaemia and inappropriate steroid use have been widely suggested as tentative reasons, we explore other biological, iatrogenic, and environmental factors. The likelihood of a two-hit pathogenesis remains strong. We propose that COVID-19 itself provides the predisposition to invasive mucormycosis (first hit), through upregulation of GRP78 and downregulation of spleen tyrosine kinase involved in anti-fungal defense, as also through inhibition of CD8+ Tcell mediated immunity. The other iatrogenic and environmental factors may provide the second hit which may have resulted in the surge.
AB - There has been a surge of mucormycosis cases in India in the wake of the second wave of COVID19 with more than 40000 cases reported. Mucormycosis in patients of COVID-19 in India is at variance to other countries where Aspergillus, Pneumocystis, and Candida have been reported to be the major secondary fungal pathogens. We discuss the probable causes of the mucormycosis epidemic in India. Whereas dysglycaemia and inappropriate steroid use have been widely suggested as tentative reasons, we explore other biological, iatrogenic, and environmental factors. The likelihood of a two-hit pathogenesis remains strong. We propose that COVID-19 itself provides the predisposition to invasive mucormycosis (first hit), through upregulation of GRP78 and downregulation of spleen tyrosine kinase involved in anti-fungal defense, as also through inhibition of CD8+ Tcell mediated immunity. The other iatrogenic and environmental factors may provide the second hit which may have resulted in the surge.
KW - GRP78
KW - Rhino-orbito-cerebral
KW - Rhizopus
KW - Spleen tyrosine kinase
UR - http://www.scopus.com/inward/record.url?scp=85124413364&partnerID=8YFLogxK
U2 - 10.14336/AD.2021.0811
DO - 10.14336/AD.2021.0811
M3 - Review article
AN - SCOPUS:85124413364
SN - 2152-5250
VL - 13
SP - 24
EP - 28
JO - Aging and Disease
JF - Aging and Disease
IS - 1
ER -