The Pathogenetic Dilemma of Post-COVID-19 Mucormycosis in India

Sankha Shubhra Chakrabarti, Upinder Kaur, Sushil Kumar Aggarwal, Ahalya Kanakan, Adesh Saini, Bimal Kumar Agrawal, Kunlin Jin, Sasanka Chakrabarti

Research output: Contribution to journalReview articlepeer-review

7 Scopus citations


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.

Original languageEnglish
Pages (from-to)24-28
Number of pages5
JournalAging and Disease
Issue number1
StatePublished - 1 Feb 2022


  • GRP78
  • Rhino-orbito-cerebral
  • Rhizopus
  • Spleen tyrosine kinase


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