Generic placeholder image

Current Diabetes Reviews

Editor-in-Chief

ISSN (Print): 1573-3998
ISSN (Online): 1875-6417

Review Article

Diabetic Ketoacidosis (DKA), a Leading Risk Factor for Mucormycosis (Black Fungus), during the Era of Coronavirus Disease-2019 (COVID-19): An Overview

Author(s): Nadeem Rais*, Rizwan Ahmad, Akash Ved, Kehkashan Parveen, Darakhshan Gazala Bari and Om Prakash

Volume 19, Issue 1, 2023

Published on: 12 April, 2022

Article ID: e150322202260 Pages: 13

DOI: 10.2174/1573399818666220315162424

Price: $65

Abstract

Introduction: Diabetes mellitus (DM) and steroid medication, coincided with coronavirus disease 2019 (COVID-19), results in a weakened immune system, allowing some commonly found pathogens to become more harmful. Mucormycosis (black fungus) is a type of opportunistic infection caused by fungi belonging to the Mucorales family. DM is the most prominent risk factor for mucormycosis. Excessive blood sugar and decreased insulin levels lead to diabetic ketoacidosis (DKA), a devastating complication of DM that can be fatal if left untreated.

Methods: Diabetic ketoacidosis is more common in type 1 diabetic patients, although it can also be fall in type 2 diabetic patients. DKA occurs when the body lacks enough insulin to allow blood sugar to enter the cells and is used for energy. Instead, the liver breaks down fat for fuel-producing chemicals known as ketones.

Results: When too many ketones are created too quickly, they can reach dangerously high levels in the body. Mucormycosis is a rare but serious infectious disease that requires medication or surgical removal.

Conclusion: The confluence of diabetes and COVID-19 makes managing mucormycosis a serious and dead issue. Although the effectiveness of prophylactic antifungal therapy has yet to be demonstrated, hyperglycemia control appears to be the most important step in managing mucormycosis in DKA patients.

Keywords: Diabetic ketoacidosis, mucormycosis, COVID-19, corticosteroid, black fungus, diabetes.

[1]
John TM, Jacob CN, Kontoyiannis DP. When uncontrolled diabetes mellitus and severe COVID-19 converge: The perfect storm for mucormycosis. J Fungi (Basel) 2021; 7(4): 298.
[http://dx.doi.org/10.3390/jof7040298] [PMID: 33920755]
[2]
Eledrisi MS, Beshyah SA, Malik RA. Management of diabetic ketoacidosis in special populations. Diabetes Res Clin Pract 2021; 174: 108744.
[http://dx.doi.org/10.1016/j.diabres.2021.108744] [PMID: 33713717]
[3]
Richardson M. The ecology of the Zygomycetes and its impact on environmental exposure. Clin Microbiol Infect 2009; 15 (Suppl. 5): 2-9.
[http://dx.doi.org/10.1111/j.1469-0691.2009.02972.x] [PMID: 19754749]
[4]
Petrikkos G, Skiada A, Lortholary O, Roilides E, Walsh TJ, Kontoyiannis DP. Epidemiology and clinical manifestations of mucormycosis. Clin Infect Dis 2012; 54 (Suppl. 1): S23-34.
[http://dx.doi.org/10.1093/cid/cir866] [PMID: 22247442]
[5]
Afroze SN, Korlepara R, Rao GV, Madala J. Mucormycosis in a diabetic patient: A case report with an insight into its pathophysiology. Contemp Clin Dent 2017; 8(4): 662-6.
[http://dx.doi.org/10.4103/ccd.ccd_558_17] [PMID: 29326525]
[6]
Moorthy A, Gaikwad R, Krishna S, et al. SARS-CoV-2, Uncontrolled diabetes and corticosteroids-an unholy trinity in invasive fungal infections of the maxillofacial region? A retrospective, multi-centric analysis. J Maxillofac Oral Surg 2021; 20(3): 1-8.
[http://dx.doi.org/10.1007/s12663-021-01532-1] [PMID: 33716414]
[7]
Yamin HS, Alastal AY, Bakri I. Pulmonary mucormycosis over 130 years: A case report and literature review. Turk Thorac J 2017; 18(1): 1-5.
[http://dx.doi.org/10.5152/TurkThoracJ.2017.16033] [PMID: 29404149]
[8]
Chander J, Kaur M, Singla N, et al. Mucormycosis: Battle with the deadly enemy over a five-year period in India. J Fungi (Basel) 2018; 4(2): 46.
[http://dx.doi.org/10.3390/jof4020046] [PMID: 29642408]
[9]
Bhatt K, Agolli A, Patel MH, et al. High mortality co-infections of COVID-19 patients: Mucormycosis and other fungal infections. Discoveries (Craiova) 2021; 9(1): e126.
[http://dx.doi.org/10.15190/d.2021.5] [PMID: 34036149]
[10]
Prakash H, Chakrabarti A. Epidemiology of Mucormycosis in India. Microorganisms 2021; 9(3): 523.
[http://dx.doi.org/10.3390/microorganisms9030523] [PMID: 33806386]
[11]
Skiada A, Pagano L, Groll A, et al. European Confederation of Medical Mycology Working Group on Zygomycosis. Zygomycosis in Europe: Analysis of 230 cases accrued by the registry of the European Confederation of Medical Mycology (ECMM) Working Group on Zygomycosis between 2005 and 2007. Clin Microbiol Infect 2011; 17(12): 1859-67.
[http://dx.doi.org/10.1111/j.1469-0691.2010.03456.x] [PMID: 21199154]
[12]
Lanternier F, Dannaoui E, Morizot G, et al. French Mycosis Study Group. A global analysis of mucormycosis in France: The RetroZygo Study (2005-2007). Clin Infect Dis 2012; 54 (Suppl. 1): S35-43.
[http://dx.doi.org/10.1093/cid/cir880] [PMID: 22247443]
[13]
Pagano L, Valentini CG, Posteraro B, et al. Zygomycosis in italy: A survey of FIMUA-ECMM (Federazione italiana di micopatologia umana ed animale and european confederation of medical mycology). J Chemother 2009; 21(3): 322-9.
[http://dx.doi.org/10.1179/joc.2009.21.3.322] [PMID: 19567354]
[14]
Patel A, Kaur H, Xess I, et al. A multicentre observational study on the epidemiology, risk factors, management and outcomes of mucormycosis in India. Clin Microbiol Infect 2020; 26(7): 944.e9-944.e15.
[http://dx.doi.org/10.1016/j.cmi.2019.11.021] [PMID: 31811914]
[15]
Kennedy KJ, Daveson K, Slavin MA, et al. Australia and new zealand mycoses interest group of the Australasian society for infectious diseases. Mucormycosis in Australia: Contemporary epidemiology and outcomes. Clin Microbiol Infect 2016; 22(9): 775-81.
[http://dx.doi.org/10.1016/j.cmi.2016.01.005] [PMID: 26806139]
[16]
Stemler J, Hamed K, Salmanton-García J, et al. Mucormycosis in the middle east and north africa: Analysis of the FungiScope® registry and cases from the literature. Mycoses 2020; 63(10): 1060-8.
[http://dx.doi.org/10.1111/myc.13123] [PMID: 32485012]
[17]
Eledrisi MS, Elzouki AN. Management of diabetic ketoacidosis in adults: A narrative review. Saudi J Med Med Sci 2020; 8(3): 165-73.
[http://dx.doi.org/10.4103/sjmms.sjmms_478_19] [PMID: 32952507]
[18]
Nasa P, Chaudhary S, Shrivastava PK, Singh A. Euglycemic diabetic ketoacidosis: A missed diagnosis. World J Diabetes 2021; 12(5): 514-23.
[http://dx.doi.org/10.4239/wjd.v12.i5.514] [PMID: 33995841]
[19]
Alekseyev K, Didenko L, Chaudhry B. Rhinocerebral mucormycosis and COVID-19 pneumonia. J Med Cases 2021; 12(3): 85-9.
[http://dx.doi.org/10.14740/jmc3637] [PMID: 33984095]
[20]
Johnson AK, Ghazarian Z, Cendrowski KD, Persichino JG. Pulmonary aspergillosis and mucormycosis in a patient with COVID-19. Med Mycol Case Rep 2021; 32: 64-7.
[http://dx.doi.org/10.1016/j.mmcr.2021.03.006] [PMID: 33842203]
[21]
Sittig KR, Laageide LG, Akhtar Z, Wall GC, Kumar SC. Cutaneous mucormycosis in a chronic lymphocytic leukemia patient on ibrutinib. IDCases 2021; 24: e01120.
[http://dx.doi.org/10.1016/j.idcr.2021.e01120] [PMID: 33912391]
[22]
Spellberg B, Edwards J Jr, Ibrahim A. Novel perspectives on mucormycosis: Pathophysiology, presentation, and management. Clin Microbiol Rev 2005; 18(3): 556-69.
[http://dx.doi.org/10.1128/CMR.18.3.556-569.2005] [PMID: 16020690]
[23]
Krishna V, Morjaria J, Jalandari R, Omar F, Kaul S. Autoptic identification of disseminated mucormycosis in a young male presenting with cerebrovascular event, multi-organ dysfunction and COVID-19 infection. IDCases 2021; 25: e01172.
[http://dx.doi.org/10.1016/j.idcr.2021.e01172] [PMID: 34075329]
[24]
Singh AK, Singh R, Joshi SR, Misra A. Mucormycosis in COVID-19: A systematic review of cases reported worldwide and in India. Diabetes Metab Syndr 2021; 15(4): 102146.
[http://dx.doi.org/10.1016/j.dsx.2021.05.019] [PMID: 34192610]
[25]
Rais N, Ahmad R, Ved A, et al. Diabetes mellitus during the pandemic Covid-19: Prevelance, pathophysiology, mechanism, and management: an updated overview. Curr Diab Revi 2021; 17.
[http://dx.doi.org/10.2174/1573399817666210712160651]
[26]
Gazzaz ZJ. Diabetes and COVID-19. Open Life Sci 2021; 16(1): 297-302.
[http://dx.doi.org/10.1515/biol-2021-0034] [PMID: 33817321]
[27]
Mascolo A, Scavone C, Rafaniello C, et al. The role of renin-angiotensin-aldosterone system in the heart and lung: Focus on COVID-19. Front Pharmacol 2021; 12: 667254.
[http://dx.doi.org/10.3389/fphar.2021.667254] [PMID: 33959029]
[28]
Peng J, Wang Q, Mei H, et al. Fungal co-infection in COVID-19 patients: Evidence from a systematic review and meta-analysis. Aging (Albany NY) 2021; 13(6): 7745-57.
[http://dx.doi.org/10.18632/aging.202742] [PMID: 33744863]
[29]
Skiada A, Pavleas I, Drogari-Apiranthitou M. Epidemiology and diagnosis of mucormycosis: An update. J Fungi (Basel) 2020; 6(4): 265.
[http://dx.doi.org/10.3390/jof6040265] [PMID: 33147877]
[30]
Rais N, Ved A, Ahmad R, Parveen K, Prakash O. Prevalence of diabetes mellitus and socio-demographic survey in the community of western uttar pradesh, india in the year 2019-2020. Int J Curr Res Rev 2021; 13(1): 10-5.
[http://dx.doi.org/10.31782/IJCRR.2021.13129]
[31]
Deccan Herald Web Desk. Covid-19 crisis: Which states in India have reported the highest number of mucormycosis cases? 2021. Available from: www.deccanherald.com/national/covid-19-crisis-which-states-in-india-have-reported-the-highest-number-of-mucor-mycosis-cases-988666.html (Accessed 07 July 2021).
[32]
Divakar PK. Fungal taxa responsible for mucormycosis/“black fungus” among COVID-19 patients in India. J Fungi (Basel) 2021; 7(8): 641.
[http://dx.doi.org/10.3390/jof7080641] [PMID: 34436180]
[33]
Corzo-León DE, Chora-Hernández LD, Rodríguez-Zulueta AP, Walsh TJ. Diabetes mellitus as the major risk factor for mucormycosis in Mexico: Epidemiology, diagnosis, and outcomes of reported cases. Med Mycol 2018; 56(1): 29-43.
[http://dx.doi.org/10.1093/mmy/myx017] [PMID: 28431008]
[34]
Kr PK. Mucormycosis. A black fungus- post covid complications. J Regen Biol Med 2021; 3(4): 1-8.
[http://dx.doi.org/10.37191/Mapsci-2582-385X-3(4)-078]
[35]
Mtibaa L, Halwani C, Tbini M, et al. Successful treatment of rhino-facial mucormycosis in a diabetic patient. Med Mycol Case Rep 2020; 27: 64-7.
[http://dx.doi.org/10.1016/j.mmcr.2020.01.003] [PMID: 32123659]
[36]
Chakrabarti A, Chatterjee SS, Das A, et al. Invasive zygomycosis in India: Experience in a tertiary care hospital. Postgrad Med J 2009; 85(1009): 573-81.
[http://dx.doi.org/10.1136/pgmj.2008.076463] [PMID: 19892892]
[37]
Prakash H, Ghosh AK, Rudramurthy SM, et al. A prospective multicenter study on mucormycosis in India: Epidemiology, diagnosis, and treatment. Med Mycol 2019; 57(4): 395-402.
[http://dx.doi.org/10.1093/mmy/myy060] [PMID: 30085158]
[38]
Priya P, Ganesan V, Rajendran T, Geni VG. Mucormycosis in a tertiary care center in south India: A 4-year experience. Indian J Crit Care Med 2020; 24(3): 168-71.
[http://dx.doi.org/10.5005/jp-journals-10071-23387] [PMID: 32435094]
[39]
Alabaz D. Yılmaz G, Uğuz A, Özdemir S, Şaşmaz İ Bayram İ. Mucormycosis in a pediatric population: A review of 20 cases from southern Turkey. Turk J Pediatr 2021; 63(1): 11-22.
[http://dx.doi.org/10.24953/turkjped.2021.01.002] [PMID: 33686822]
[40]
Somagutta MR, Agadi K, Hange N, et al. Euglycemic diabetic ketoacidosis and sodium-glucose cotransporter-2 inhibitors: A focused review of pathophysiology, risk factors, and triggers. Cureus 2021; 13(3): e13665.
[http://dx.doi.org/10.7759/cureus.13665] [PMID: 33824816]
[41]
Al-Tawfiq JA, Alhumaid S, Alshukairi AN, et al. COVID-19 and mucormycosis superinfection: The perfect storm. Infection 2021; 49(5): 833-53.
[http://dx.doi.org/10.1007/s15010-021-01670-1] [PMID: 34302291]
[42]
Waizel-Haiat S, Guerrero-Paz JA, Sanchez-Hurtado L, Calleja-Alarcon S, Romero-Gutierrez L. A case of fatal rhino-orbital mucormycosis associated with new onset diabetic ketoacidosis and COVID-19. Cureus 2021; 13(2): e13163.
[http://dx.doi.org/10.7759/cureus.13163] [PMID: 33575155]
[43]
Liang Y, Chen X, Wang J, Guo C, Liu F, Yang J. Oral posaconazole and bronchoscopy as a treatment for pulmonary mucormycosis in pediatric acute lymphoblastic leukemia patient: A case report. Medicine (Baltimore) 2021; 100(6): e24630.
[http://dx.doi.org/10.1097/MD.0000000000024630] [PMID: 33578579]
[44]
Miller RP, Farrugia L, Leask J, Khalsa K, Khanna N, Melia L. Successful treatment of Rhizopus arrhizus rhino-orbital-cerebral mucormycosis with isavuconazole salvage therapy following extensive debridement. Med Mycol Case Rep 2021; 32: 39-42.
[http://dx.doi.org/10.1016/j.mmcr.2021.03.005] [PMID: 33816097]
[45]
Wong TY, Loo YS, Veettil SK, et al. Efficacy and safety of posaconazole for the prevention of invasive fungal infections in immunocompromised patients: A systematic review with meta-analysis and trial sequential analysis. Sci Rep 2020; 10(1): 14575.
[http://dx.doi.org/10.1038/s41598-020-71571-0] [PMID: 32884060]
[46]
Saldanha M, Reddy R, Vincent MJ. Title of the article: Paranasal mucormycosis in COVID-19 Patient. Indian J Otolaryngol Head Neck Surg 2021; 1-4: 1-4.
[http://dx.doi.org/10.1007/s12070-021-02574-0] [PMID: 33903850]
[47]
Rais N, Ved A, Ahmad R, Parveen K. Potential of S-allyl cysteine, a major bioactive component of garlic, as hypoglycemic and hypolipidemic agentl. Curr Res Diabetes Obes J 2021; 14(4): 555895.
[http://dx.doi.org/10.19080/CRDOJ.2021.14.555895]
[48]
Torabiyan S, Dalfardi B, Sanjari M. Asymptomatic COVID-19 as a risk factor of diabetic ketoacidosis and mucormycosis: A case report and review of the literature. Case Rep Endocrinol 2021; 2021: 2765867.
[http://dx.doi.org/10.1155/2021/2765867] [PMID: 34777880]
[49]
Prakash H, Skiada A, Paul RA, Chakrabarti A, Rudramurthy SM. Connecting the dots: Interplay of pathogenic mechanisms between COVID-19 disease and mucormycosis. J Fungi (Basel) 2021; 7(8): 616.
[http://dx.doi.org/10.3390/jof7080616] [PMID: 34436155]
[50]
Wang Y, Zhang L, Li Q, et al. The significant immune escape of pseudotyped SARS-CoV-2 variant Omicron. Emerg Microbes Infect 2022; 11(1): 1-5.
[http://dx.doi.org/10.1080/22221751.2021.2017757] [PMID: 34890524]

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy