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Intercepting the deadly trinity of mucormycosis, diabetes and COVID-19 in India
  1. Mainak Banerjee1,
  2. Rimesh Pal2,
  3. Sanjay K Bhadada2
  1. 1Endocrinology, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
  2. 2Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
  1. Correspondence to Dr Sanjay K Bhadada, Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India; bhadadask{at}

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Of late, several cases of COVID-19-associated mucormycosis (CAM) are being reported worldwide. Although a causal link between COVID-19 and mucormycosis remains unearthed, multiple factors including glucocorticoids, worsening blood glucose control, ketoacidosis, increased serum-free iron (due to hyperferritinemia and acidosis), and viral-induced lymphopenia have been implicated in the pathogenesis of CAM.1

Notably, most of the cases of CAM have been reported from India.2 India, per se, has the highest burden of mucormycosis globally, with an estimated prevalence of 140 cases per million population. Besides, India is home to nearly 77 million people with diabetes; unarguably, diabetes mellitus is a major risk factor for mucormycosis.3 Nevertheless, there has been an unprecedented and alarming upsurge in the number of cases of CAM across several states, as the second wave of the COVID-19 pandemic continues to rampage in India. Until 19 May 2021, approximately 5500 people were affected with CAM in India, resulting in 126 casualties.4 Subsequently, CAM has been declared an epidemic disease in many states across the country.

Amid this raging cataclysm, it is crucial to reflect on the possible reasons and ways to tide over the additional crisis of the ‘black fungus’. As always, prevention is better than cure. …

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  • Contributors MB, RP and SKB all contributed equally.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.