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During the COVID-19 pandemic, a significant increase in cases of mucormycosis was observed in COVID-19 patients, especially in India, but not exclusively. The presented cases highlight the heterogeneous nature of mucormycosis, emphasizing the importance of recognizing predisposing factors, such as immunosuppression, due to comorbidities or medication. Diagnosing mucormycosis poses a challenge due to nonspecific clinical manifestations, requiring a multidisciplinary approach for accurate diagnosis. Treatment involves a multi-pronged approach centered around the early initiation of antifungal therapy alongside surgical intervention and the management of underlying conditions, with an emphasis on controlling immunosuppression. Understanding the relationship between COVID-19 and predisposing factors for mucormycosis is fundamental for developing prevention and treatment strategies. [ABSTRACT FROM AUTHOR]

During the catastrophic wave of Coronavirus disease 2019, health agencies started to report an infrequent but lethal mucormycosis or black fungal infection. Primarily, it causes sinusitis by affecting nasal, oral, lung, brain, ocular, and other body tissues. It becomes more fatal, especially in diabetic, cancer, and immune‐compromised patients. Before 2020, the prevalence of mucormycosis was very rare but it has rapidly emerged globally from late 2020 to mid‐2021. Recently, the mucormycosis got worse and epidemic with more than 30,000 cases reported across India. The etiology of infection can be diagnosed by molecular, serological, microscopic, and clinical methods. However, early diagnosis of this ailment is still a challenging task due to no standalone diagnostic tool available along with clinical manifestations of the ailment resembling other fungal diseases. The treatment of mucormycosis is also challenging and frequently requires long‐term treatment. Amphotericin B was found to be an effective antifungal for preventing mucormycosis but it failed if infection disseminated to necrotizing tissues or adjacent organs. Removal of infected tissue/organ by surgery is an alternative treatment to control mucormycosis. In addition, reversal of underlying predisposing conditions based on therapy is also in practice for its prevention. This review highlights different aspects of mucormycosis such as pathogenesis, diagnosis, treatment, and their challenges and so on. We also emphasized the epidemiological shift during the recent outbreak and its influence on the different regions of India. [ABSTRACT FROM AUTHOR]

In India, COVID-19 has led to a surge in cases of a potentially fatal fungal infection called mucormycosis, popularly known as "black fungus." Intravenous amphotericin B is the only available drug for salvage therapy. Efforts to improve its therapeutic efficacy and decrease its nephrotoxicity have focussed on the reformulation of AmB in three new lipid formulations such amphotericin B lipid complex (Abelcet), amphotericin B colloidal dispersion (Amphotec), and liposomal amphotericin B (AmBisome). The aim of this study is (1) to evaluate the adverse drug reaction of various formulations of amphotericin B used for the treatment of rhinooculocerebralmucormycosis in Indian population. (2) to evaluate the adverse drug reaction of injectable form of posaconazole. This prospective observational study was done on a random sample of 110 patients who got admitted for the management of rhinooculocerebral mucormycosis in a tertiary care centre of middle india... The patients were assessed for the adverse reactions following the administration of various antifungal medication and the findings were analysed. All the 110 patients had received two forms of Amphotericin B (liposomal Amphotericin B and Amphotericin B lipid complex) and Posaconazole injection. 60 patients had received all three forms of Amphotericin B. Out of the 110 patients who received Liposomal amphotericin B, only 2 patients developed adverse drug reaction while in 110 patients who received Amphotericin B Lipid complex, 7 patients had adverse drug effects. Lyophilised amphotericin B had been administered to 60 patients in which 51 patients developed adverse drug reaction and in them one patient went to congestive cardiac failure. Injection posaconazole had been administered to 110 patients in which 72 patients developed drug reaction. In spite of its proven track record of Amphotericin B, its well-known side effects and toxicity will sometimes require discontinuation of therapy despite a life-threatening systemic fungal infection. Lipid formulations of AmB are better tolerated than AmB deoxycholate but infusional drug reactions have been reported in lipid formulation too. So improved strategies for the management of infusion related adverse events are required. [ABSTRACT FROM AUTHOR]

The emergence of various diseases during the COVID-19 pandemic made health workers more attentive, and one of the new pathogens is the black fungus (mucormycosis). As a result, millions of lives have already been lost. As a result of the mutation, the virus is constantly changing its traits, including the rate of disease transmission, virulence, pathogenesis, and clinical signs. A recent analysis revealed that some COVID-19 patients were also coinfected with a fungal disease called mucormycosis (black fungus). India has already categorized the COVID-19 patient black fungus outbreak as an epidemic. Only a few reports are observed in other countries. The immune system is weakened by COVID-19 medication, rendering it more prone to illnesses like black fungus (mucormycosis). COVID-19, which is caused by a B.1.617 strain of the SARS-CoV-2 virus, has been circulating in India since April 2021. Mucormycosis is a rare fungal infection induced by exposure to a fungus called mucormycete. The most typically implicated genera are Mucorrhyzuprhizopusdia and Cunninghamella. Mucormycosis is also known as zygomycosis. The main causes of infection are soil, dumping sites, ancient building walls, and other sources of infection (reservoir words "mucormycosis" and "zygomycosis" are occasionally interchanged). Zygomycota, on the other hand, has been identified as polyphyletic and is not currently included in fungal classification systems; also, zygomycosis includes Entomophthorales, but mucormycosis does not. This current review will be focused on the etiology and virulence factors of COVID-19/mucormycosis coinfections in COVID-19-associated mucormycosis patients, as well as their prevalence, diagnosis, and treatment. [ABSTRACT FROM AUTHOR]

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been associated with a wide range of opportunistic bacterial and fungal infections. Recently, several cases of mucormycosis in people with COVID-19 have been increasingly reported worldwide, in particular in India. 1. To study the total prevalence of mucormycosis and other fungal species in patients' samples. 2. To elaborate on the associated underlying risk factors and their presentations with COVID-19. The study was conducted at the Department of Microbiology, Kalpana Chawla Government Medical College from April 2021 to July 2021 during the COVID-19 pandemic. Both outpatient and admitted cases were included in the study suspected of mucormycosis with underlying COVID-19 infection or post-recovery phase. In total, 906 nasal swab samples were collected at the time of the visit from suspected patients and were sent to the microbiology laboratory of our institute for processing. Both microscopic examinations by preparing a wet mount with KOH and lactophenol cotton blue stain and culture using Sabouraud's dextrose agar (SDA) were done. Subsequently, we analyzed the patient's clinical presentations at a hospital, associated comorbidities, site of mucormycosis infection, past history for use of steroids or oxygen therapy, admissions required, and its outcome in patients with COVID-19. In total, 906 nasal swabs from suspected cases of mucormycosis in people with COVID-19 were processed. In all, 451 (49.7%) fungal positivity was seen, out of which 239 (26.37%) were mucormycosis. Other fungi such as Candida (175, 19.3%), Aspergillus 28 (3.1%), Trichosporon (6, 0.66%) and Curvularia (0.11%) were also identified. Out of the total, 52 were mixed infections. The total percentage of patients having underlying active COVID-19 infection or in the post-recovery phase was 62%. Most cases (80%) were of rhino-orbital origin, 12% were Pulmonary and the rest 8% where no primary site of infection was confirmed. Among risk factors, pre-existing diabetes mellitus (DM), or acute hyperglycemia was present in 71% of cases. Corticosteroid intake was recorded in 68% of cases, chronic hepatitis infection in 4%, two cases of chronic kidney disease, and only one case with triple infection of COVID-19, underlying HIV, and pulmonary tuberculosis. Death from fungal infection was reported in 28.7% of the cases. Even with rapid diagnosis, treatment of underlying disease, and aggressive medical and surgical intervention, the management is often not effective, leading to an extension of the infection and ultimately death. So, early diagnosis and prompt management of this suspected new emerging fungal infection with COVID-19 should be considered. [ABSTRACT FROM AUTHOR]

Background: The term mucormycosis refers to any fungal infection caused by fungi belonging to the Mucorales order. The disease often manifests in the skin and also affects the lungs and the brain. A large number of Mucormycosis cases were detected in Delhi, Maharashtra and Gujarat, and Madhya Pradesh. Objectives: (1) To describe the epidemiology, management, and outcome of individuals with mucormycosis. (2) To evaluate the risk factors associated with cases and control. Methodology: A case–control study, conducted in Hamidia Hospital, Bhopal, for 5 weeks. One hundred and sixty-eight patients diagnosed clinically with radiological or pathological findings was considered a case of Mucormycosis. Control was taken from March 2020 to May 28, 2021, the list of COVID-19-positive patients obtained from IDSP, MP. Results: Majority of the study participants were among the age group of 51–60 years and comprising 69.6% of males. Diabetes mellitus is the major comorbidity found in both cases (87.58%) and in controls (20.0%). Conclusion: There is a need to stress to control hyperglycemia, and monitor blood glucose levels after discharge following COVID-19 treatment. [ABSTRACT FROM AUTHOR]

While the world is still struggling with the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, an aggressive and rare fungal infection which is commonly ascribed as the black fungus has emerged as a new medical challenge in India. India had already experienced the devastating consequences of the COVID-19 and, being a rare "opportunistic" fungal infection, black fungus infection has severely complicated the post-COVID-19 recoveries. Together with the uncertain treatment modalities at the beginning of the pandemic, indiscriminate use of a plethora of medications has driven the surging cases of black fungus-associated complications. Moreover, low oxygen, high iron levels, and prolonged hospitalization with mechanical ventilators created a superlative condition for contracting black fungus infection. The disease mainly spreads through the respiratory tract and erodes facial structures. Since mucormycosis specifically attacks immunosuppressed patients, the disease started spreading rapidly, with an average mortality rate of 54 %. Common symptoms include blackening over the nose, blurred or double vision, breathing difficulties, chest pain and hemoptysis. Although not contagious, the outcome of the disease is often very frightful. If the infection disseminates systematically, the risk of affecting the vital organs such as the spleen and heart is substantially high. We have tried to provide an epidemiological overview of black fungus infection in India. We focused on drawing a comprehensive fact check of the current situation through an immunological perspective to better understand the infection as a major co-infection in patients affected by COVID-19 and its impact on India's fight against the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

As everyone knows that in today's time Artificial Intelligence, Machine Learning and Deep Learning are being used extensively and generally researchers are thinking of using them everywhere. At the same time, we are also seeing that the second wave of corona has wreaked havoc in India. More than 4 lakh cases are coming in 24 h. In the meantime, news came that a new deadly fungus has come, which doctors have named Mucormycosis (Black fungus). This fungus also spread rapidly in many states, due to which states have declared this disease as an epidemic. It has become very important to find a cure for this life-threatening fungus by taking the help of our today's devices and technology such as artificial intelligence, data learning. It was found that the CT-Scan has much more adequate information and delivers greater evaluation validity than the chest X-Ray. After that the steps of Image processing such as pre-processing, segmentation, all these were surveyed in which it was found that accuracy score for the deep features retrieved from the ResNet50 model and SVM classifier using the Linear kernel function was 94.7%, which was the highest of all the findings. Also studied about Deep Belief Network (DBN) that how easy it can be to diagnose a life-threatening infection like fungus. Then a survey explained how computer vision helped in the corona era, in the same way it would help in epidemics like Mucormycosis. [ABSTRACT FROM AUTHOR]

The catastrophic phase of Covid-19 turns the table over with the spread of its disastrous transmission network throughout the world. Covid-19 associated with mucormycosis fungal infection accompanied by opportunistic comorbidities have emerged the myriad of complications and manifestations. We searched the electronic databases of Google Scholar, PubMed, Springer, and Elsevier until June 05, 2021, using keywords. We retrieved the details of confirmed and suspected mucormycosis patients associated with Covid-19. We analyzed the case reports, treatment given for Covid-19, steroids used, associated comorbidities, mucormycosis site involved, and patients survived or dead. Overall, 102 patients of mucormycosis associated with Covid-19 have been reported from India. Mucormycosis was predominant in males (69.6%) rather than females (19.6%), and most of the patients were active Covid-19 cases (70.5%). Steroids were mostly used (68.6%) for the treatment of Covid-19 followed by remdesivir (10.7%). Patients were suffering from diabetes mellitus (88.2%) and severe diabetic ketoacidosis (11.7%). Mucormycosis affects the sino-nasal (72.5%), orbit (24.5%), central nervous system (18.6%), and maxillary necrosis (13.7%) of the patients. The Mortality rate was recorded as 23.5%, and recovery rate was 2.9%. Diabetes mellitus cases are highest in India as compared to other countries, and prevalent use of steroids with the background of Covid-19 becomes an opportunistic environment for mucormycosis fungal infection to survive. [ABSTRACT FROM AUTHOR]

Mucormycosis is a fungal infection caused by members of Mucorales and zygomycotic species. These are saprophytes known as Mucormycotina that grow from rotten matter or soils during the decomposition of soil. It has been seen affecting many COVID-19-affected patients recently in India. Mucormycosis can be diagnosed in six different sites depending on the immunological status and the site of the body affected. The six manifestations are rhinocerebral, pulmonary, cutaneous, gastrointestinal, and central nervous system or disseminated forms. Here, we present a dental case of mucormycosis or black fungus disease that has affected an immune-compromised patient who had suffered from COVID-19 2 months ago. Surgical debridement was done and the histopathologic study revealed fungal hyphae. Systemic antifungal therapy was administered that helped the patient to recover in 7-week time. [ABSTRACT FROM AUTHOR]

Background: During the second wave of the COVID-19 pandemic, an unusual increase in cases of mucormycosis was observed in India, owing to immunological dysregulation caused by the SARS-CoV-2 and the use of broad-spectrum antibiotics, particularly in patients with poorly controlled diabetes with ketoacidosis to have contributed to the rise, and it has been declared an epidemic in several states of India. Because of the black colouring of dead and dying tissue caused by the fungus, it was dubbed "black fungus" by several Indian media outlets. In this study, attempts were taken to unmask novel therapeutic options to treat mucormycosis disease. Rhizopus species is the primary fungi responsible for 70% of mucormycosis cases. Results: We chose three important proteins from the Rhizopus delemar such as CotH3, Lanosterol 14 alpha-demethylase and Mucoricin which plays a crucial role in the virulence of Mucorales. Initially, we explored the physiochemical, structural and functional insights of proteins and later using AutoDock Vina, we applied computational protein–ligand binding modelling to perform a virtual screening around 300 selected compounds against these three proteins, including FDA-approved drugs, FDA-unapproved drugs, investigational-only drugs and natural bioactive compounds. ADME parameters, toxicity risk and biological activity of those compounds were approximated via in silico methods. Our computational studies identified six ligands as potential inhibitors against Rhizopus delemar, including 12,28-Oxamanzamine A, vialinin B and deoxytopsentin for CotH3; pramiconazole and saperconazole for Lanosterol 14 alpha-demethylase; and Hesperidin for Mucoricin. Interestingly, 12,28-Oxamanzamine A showed a maximum binding affinity with all three proteins (CotH3: − 10.2 kcal/mol Lanosterol 14 alpha-demethylase: − 10.9 kcal/mol Mucoricin: − 8.6 kcal/mol). Conclusions: In summary, our investigation identified 12,28-Oxamanzamine A, vialinin B, deoxytopsentin, pramiconazole, saperconazole and hesperidin as potent bioactive compounds for treating mucormycosis that may be considered for further optimisation techniques and in vitro and in vivo studies. [ABSTRACT FROM AUTHOR]

Together with the ongoing serious COVID-19 second wave in India, a serious fungal infection, mucormycosis has been increasingly found in COVID-19-recovered patients. Colloquially known as 'black fungus', mucormycosis commonly causes necrosis in the head and neck including the nose, paranasal sinuses, orbits, and facial bones, with possible intracranial spread. The disease causes high morbidity and mortality given that it progresses rapidly and diagnosis is often delayed. Given the sheer magnitude of the outbreak, the Indian Health Ministry has advised all states to declare mucormycosis an epidemic. Typically, the disease has been found to be linked to COVID-19 infections caused by the B.1.617.2 (Delta) variant, which has spread rapidly throughout the country. This variant has already become a cause for global concern, having spread to at least 40 countries, including the USA and UK. We present the findings of a study conducted on COVID-19 associated mucormycosis (CAM) patients, and discuss the associated risk factors to raise awareness for OMFS colleagues. [ABSTRACT FROM AUTHOR]

Mucormycosis or black fungus infection is a rare but deadly disease with a 46-96% mortality rate depending on the underlying health condition of patients. This life-threatening new enemy has chal-lenged the Indian healthcare system during the massive second wave of covid- 19 pandemic. Mucormycosis caused by the mucorales group of fungi affecting various parts of the body. This opportunistic fungal infection progress rapidly. Recently, the covid patients in India are getting infected by this uncommon fungus at higher rates than ever. At present, the prevalence of this black fungus infection is skyrocketing among covid-19 and post-covid-19 patients in India]. Generally, black fungus affects the body surface and internal organs such as the sinus, brain, lungs, eyes, bones, nerves, body tissues and becomes fatal if left untreated. Usual signs of this disease are sinus pain, nasal blockage on one side of the face, swelling or numbness, one-sided headache, loosening of tooth and toothache, pain in the eyes, and more. The infected patients primarily suffer from eyelid loss, blindness, and blurred vision. The diagnosis and treatment of mucormycosis are challenging. The incidence of the disease seems to be increasing. Mucormycosis is an angio invasive fungal infection, due to fungi of the order Mucorales. Its incidence cannot be measured exactly, since there are few population-based studies, but multiple studies have shown that it is increasing. Patients who have high levels of diabetes are at a higher risk of contracting covid-19. When this occurs, they are treated with steroids which compromise their immunity. According to doctors, steroids can prove to be a trigger for mucormycosis. While steroids help in reducing inflammation in lungs they can decrease immunity and increase blood sugar levels in both diabetics and non-diabetic covid-19 patients alike. The black fungus disease is an additional burden on the country that is already grappling with more cases and fatalities due to the second wave of the covid-19 pandemic. [ABSTRACT FROM AUTHOR]

Mucormycosis is caused by fungi belonging to the order Mucorales. The term "Black Fungus" has been widely applied to human pathogenic Mucorales in India. They mainly infect the sinuses and brain, lungs, stomach and intestines, and skin. While this has been considered a rare disease, thousands of cases have been reported during the second wave of COVID-19 in India, between the months of April and June 2021. Hitherto, more than 45,374 cases and over 4300 deaths have been reported among COVID-19 patients across India from April 2021 to July 21, 2021. Though the mortality rate is estimated to be 50%, it could be above 90% if left untreated. In India, Rhizopus arrhizus has been related to be the most common species to cause human mucormycosis, followed by Apophysomyces variabilis, Rhizopus microsporus, and R. homothallicus. Accurate sample identification of human pathogenic Mucorales species is challenging especially due to the frequent lack of diagnostic morphological features. Traditionally, the culture-based approach has been extensively used to isolate and characterize human pathogenic Mucorales. However, this may not be an appropriate approach to objectively isolate and characterize all species, as the germination and growth of fungal spores are highly dependent on culture media and environmental conditions. Therefore, a robust approach to the accurate and rapid identification of human pathogenic Mucorales species is a prerequisite. The metagenomic approach comprehensively sequences and analyzes all genetic material in a complex biological sample and, consequently, this could be an appropriate approach to objectively characterize human pathogenic Mucorales taxa without the need for in vitro culture. The precise identification of the species will not only be useful for the correct diagnosis of this disease, but also for the development of antifungal drugs specific for each species. Accurate and rapid species identification is desperately needed to save lives in the mucormycosis outbreak among COVID-19 patients in India and neighboring countries. [ABSTRACT FROM AUTHOR]

Black fungus also known as Mucormycosis, has recently devastated some states of India. It has been declared pandemic now. Inhibitors of glucon synthesis pathways have been evaluated to curtail the Mucormycosis but still at infancy stage. Due to key role in glucon synthesis, in the present study β -glucan synthase has been regarded as a suitable target for drug design. In-silico docking and pharmacological study was designed to evaluate the effect of potent bioactive molecule 1-8 cineole present in essential oils of eucalyptus plant leaves against β -glucan synthase enzyme. Till date there is no work is undertaken on insilico analysis of this compound against β -glucan synthase. Patch-dock analysis was used for docking. Ligand Protein 2D and 3D Interactions were also studied. Drug likes and toxicity profile was also evaluated. Cancer cell line toxicity profile was also studied. The calculated parameters such as docking score indicated effective binding of 1-8 cineole to β - glucan synthase -protein. Interactions results indicated that, β -glucan synthase enzyme and 1-8 cineole complexes forms hydrogen and hydrophobic interactions. 1-8 cineole also depicted sufficient level of cancer cell line toxicity. Drug likeliness profiles by assaying absorption, distribution, metabolism, excretion and toxicity (ADMET) studies provided guidelines and mechanistic scope for identification of 1-8 cineole as potent anti-fungal drug. Therefore, essential oil from eucalyptus may represent potential herbal treatment to act as anti-fungal drug. [ABSTRACT FROM AUTHOR]

The COVID-19 cases and the death toll are increasing in India with time so is the demand for an improved healthcare system. This critical situation demands a huge medical infrastructure with sufficient medical personnel. This pandemic has also led to an increase in demand for medical equipment in different parts of India, which is causing clinical consternations during treatment procedures. This paper confers the current situation being faced by the healthcare system in India and provide a descriptive analysis of the current situation, which would act as a situational guide for the policymakers. This paper has also reviewed recent literature on the current healthcare crises including the occurrence of mucormycosis in India and even highlights the shortcomings of the vaccination policy in the country. [ABSTRACT FROM AUTHOR]

Mucormycosis, a deadly fungal infection, has affected thousands of COVID-19 patients in India. Mucormycosis, formerly known as zygomycosis, is caused by the many fungi that belong to the family “Mucorales.” These molds are commonly found in soil, air, and damp walls and frequently colonize oral mucosa, nose, paranasal sinuses, and throat. The pathophysiological consequences of diabetes combined with the acute inflammatory surge in COVID-19 and steroid treatment weakens person’s immunity and renders susceptibility to fungal infections. Patients treated for severe COVID-19 have damaged lungs and suppressed immune system, an environment that supports fungal infection. Fungal spores can grow in airways or sinuses, and invade bodies’ tissues, explaining why the nasal cavity and paranasal sinuses are the most common site of mucormycosis infection, the consequential spread to the eyes can cause blindness, or causing headaches or seizures if the infection spreads to the brain. Poorly controlled diabetes often results in acidosis in tissues a suitable environment for Mucorales fungi to grow, exacerbating the risk for mucormycosis. This becomes clinically important, especially in India that has an increased prevalence of undiagnosed and uncontrolled diabetes. Given that a significant increase in the cases of mucormycosis in the diabetic patients treated for COVID-19 is strongly associated with corticosteroid administration, there is a need to evaluate use of dietary nutraceuticals with immune boosting potentials that modulate metabolic abnormalities in the management of COVID-19 associated mucormycosis. [ABSTRACT FROM AUTHOR]

COVID‐19's second wave had a significant impact on India, on May 7, 2021, the largest daily recorded case count was a little more than 4 million, and it has since fallen. Although the number of new cases reported has dropped, during the third week of May 2021, India accounted for about 45% of new cases identified globally and around 34% of deaths. As India maintains its present level of stability, a new urgent threat has emerged in the form of coronavirus‐associated mucormycosis. Mucormycosis, an acute and deadly fungal infection caused by Mucorales‐related fungal species, is a fungal emergency with a particularly aggressive propensity for contiguous spread, associated with a poor prognosis if not properly and immediately identified, and treated. Mucormycosis, sometimes referred to as the "black fungus," has increased more rapidly in India during the second wave of COVID‐19 than during the first wave, with at least 14,872 cases as of May 28, 2021. Uncontrolled diabetic mellitus (DM) and other immunosuppressive diseases such as neutropenia and corticosteroid treatment have traditionally been identified as risk factors for mucormycosis. Therefore, the use of glucocorticoids or high doses of glucocorticoids in mild COVID‐19 cases (without hypoxemia) should be avoided. In addition, drugs that target the immune pathway, such as tocilizumab, are not recommended without clear benefits. [ABSTRACT FROM AUTHOR]

Summary: In addition to the overwhelming and uncontrollable second wave of COVID‐19 in India, the country is also dealing with an outbreak of mucormycosis, a deadly fungal infection, which is affecting thousands of COVID‐19 patients. With the increasing number of cases of mucormycosis and a fatality rate of 50%, many Indian states and union territories have declared an epidemic of black fungus due to its unprecedented emergence, which has adversely affected the already debilitated health system of the country. The advent of the new fungal epidemic in the country is due to the overdosage, panic and injudicious use of corticosteroids among COVID‐19 patients, as well as their pre‐existing medical history of diabetes, given that India is the diabetes capital of the world. Thus, there is an urgent need to address this public health concern by having nationwide surveillance, diagnostic and management system of the disease, along with public awareness and education to combat the syndemic of COVID‐19 and mucormycosis in the country. [ABSTRACT FROM AUTHOR]

Purpose: To study the awareness on mucormycosis among outpatients who visited six tertiary eye care hospitals at Madurai, Pondicherry, Coimbatore, Tirunelveli, Chennai, and Tirupati., Methods: This was a telephone-based survey conducted using questionnaires consisting of 38 questions in five sections from July 5 to 25, 2021. Patients visiting the eye hospitals for an examination were contacted over their phones and responses were directly entered onto the Google forms platform., Results: A total of 4573 participants were included in the study. Among all participants, a cumulative 83% of participants had some knowledge of mucormycosis. More than 80% of them reported that their prime source of information was through mass communication like television or radio. Around 34.8% of the respondents were aware that it can occur after treatment for coronavirus disease 2019 (COVID-19) infection, only half of them (54.3%) knew that systemic steroids were the main risk factor. The knowledge scores were higher for participants who were diabetics (n = 1235) or had been affected by COVID-19 earlier (n = 456) or whose friends had mucormycosis earlier (n = 312). Knowledge, attitude, and practice (KAP) scores of nonprofessional health-care workers (n = 103) were much better compared to patients., Conclusion: Such KAP studies give us an idea of the impact of the measures taken for educating the public. In this study, a cumulative 83% of participants had some knowledge of mucormycosis and 86% knew that this was an emergency. More than 50% of the participants were not aware that diabetes is a risk factor for mucormycosis., Competing Interests: None

The second wave of the COVID-19 pandemic has affected India significantly with country reporting more than 400,000 cases in the month of May 2021 and health system almost collapsing. This was attributed to the new mutant strain also called as the 'Delta Strain' which led to high surge of cases across the country. As the country was stabilising over this situation, another imminent threat in the form of Covid Associated Mucormycosis (CAM) challenged the already burdened health system of India. Also called as 'Black Fungus,' cases of CAM began to rise rapidly in the last week of May 2021 with multiple states reporting steady rise in the number of cases. Based on the published literature, India contributed to approximately 71% of global cases of CAM from December 2019 to start of April 2021, with majority of the cases occurring during the second wave. The present paper focuses on the epidemic of CAM during the second wave in India highlighting the causes, symptoms and various treatment modalities that have been adopted to cure the disease. Also, spotlight has also been thrown on some other nations where cases of CAM have begun to emerge. Some key recommendations are also mentioned which can prove vital towards disease prevention., (© Copyright by the National Institute of Public Health NIH - National Research Institute.)