COVID-19-associated Mucormycosis: Re-exploring the Role of Steroids in the Forgotten Deadly Duo!

Introduction: Mucormycosis, a highly invasive fungal infection, re-emerged during the second wave of the COVID-19 pandemic, particularly among patients with diabetes and those treated with steroids. While steroids have been proven to reduce mortality in severe COVID-19, their role in the development of COVID-19-associated mucormycosis (CAM) remains debated. This study aims to explore the correlation between steroid use and CAM in real-world clinical settings. Methods: This retrospective observational study was conducted at two tertiary care centers in India from May to August 2021. Data were collected from 65 patients diagnosed with CAM, confirmed through clinical, radiological, and histopathological evidence. Steroid use, comorbidities, and other clinical factors were analyzed to assess their potential contribution to the development of mucormycosis. Results: The majority of CAM cases (83%) had a history of steroid use, predominantly dexamethasone, with a mean duration of 10 days. Most patients (81%) were diabetic, and 87% were over 40 years of age. Rhino-orbital mucormycosis was the most common form of infection. Diabetes and hyperglycemia were strongly associated with CAM, while 14% of patients with CAM did not receive steroids. Notably, patients who received insulin alongside steroids had a lower incidence of CAM, suggesting that insulin use mitigates the risk by controlling hyperglycemia and preventing ketosis. Conclusion: Steroid use in COVID-19 is not solely responsible for the rise in CAM. The presence of uncontrolled diabetes and the absence of insulin therapy were more critical factors.