Skin mucormycosis in dermatological practice: Dangerous coinfection during the COVID-19 pandemic (current state of the issue)

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Abstract

The coronavirus SARS-COV-2 pandemic has caused an increase in the incidence of the population and significant losses that have claimed more than 6.8 million lives worldwide. In recent years, secondary microbial co-infections have caused serious concern: influenza, tuberculosis, typhoid fever, mucormycosis, etc. At the beginning of the catastrophic wave of coronavirus disease, there were reports of a rare but deadly mucormycosis, which quickly spread throughout the world. Currently, the relevance of this complication has increased significantly due to the pandemic of a new coronavirus infection, immunosuppression, diabetes mellitus and the massive use of glucocorticosteroids for the treatment of COVID-19.

It is proposed to revise diagnostic strategies to detect secondary co-infection. First-line therapy is amphotericin B in combination with surgery. Delaying antifungai therapy and surgical excision of diseased tissue increases mucormycosis-related mortality, requiring a high level of medical skill in both diagnostic and therapeutic aspects.

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About the authors

Sofia A. Burova

National Academy of Mycology; Center for Deep Mycosis and Actinomycosis

Email: doctorburova@mail.ru
ORCID iD: 0000-0003-0017-621X

MD, Dr. Sci. (Med.), Professor

Russian Federation, 20/1 Malaya Bronnaya street, 103104 Moscow; Moscow

Alexey V. Taganov

Peoples' Friendship University of Russia

Email: matis87177@yandex.ru
ORCID iD: 0000-0001-5056-374X
SPIN-code: 1191-8991

 MD, Dr. Sci. (Med.), Professor

Russian Federation, Moscow

Anna A. Kashtanova

Moscow Regional Research and Clinical Institute

Email: acashtanova@yandex.ru

MD, Cand. Sci. (Med.)

Russian Federation, Moscow

Yulia V. Gorbacheva

Moscow Regional Research and Clinical Institute

Author for correspondence.
Email: gorbacheva.md@gmail.com

MD, Cand. Sci. (Med.)

Russian Federation, Moscow

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2. Fig. 1. Severe angioinvasive necrotizing rhinocerebral mucormycosis: a ― prosopathy, facial asymmetry, congestive hyperemia of the skin, black dry necrosis area, total ophthalmopathy, exophthalmos, chemosis, subconjunctival hemorrhage, blindness; exenteration of the eye socket; b ― necrosis of the upper jaw, walls of the right eye socket, mucosa of the hard and soft palate, pathological mobility of teeth. (Images from the archive of the author S.A. Burova).

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3. Fig. 2. Rhinoorbital mucormycosis with skin lesions: a ― the disease began with periorbital phlegmon, followed by a change in the bone structures of the facial skeleton on the left, sinusitis and skin lesions in the zygomatic area; b ― numbness and swelling of the right half of the face, inflammation, sinusitis, orbital zone lesion, exophthalmos. (Images from the archive of the author S.A. Burova).

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4. Fig. 3. Histological preparations of various patients with mucormycosis (a, b): among necrotic detritus with leukocyte infiltrate, large, wide, unsepted, slightly branching CHIC(PAS)-positive elements of mold mucormycetes are visible; c ― colonies of mucormycetes of "coccoid" shape inside the vessels with a cross-section of the drug and necrotized fragments of bone tissue. (Photos of histological preparations from the archives of the authors A.A. Kashtanova and Yu.V. Gorbacheva).

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