Mycotic infections – mucormycosis and oral candidiasis associated with Covid-19: a significant and challenging association

Figures & data

Table 1. Predisposing host factors associated with oral candidiasis and mucormycosis

Oral candidiasis	Local factors
	Use of dentures
	Inhaler use
	Decreased salivary flow
	Systemic factors
	Uncontrolled diabetes
	Immunosuppression
	Inadvertent use of broad-spectrum antibiotics/or corticosteroids
	Nutritional deficiencies*
Mucormycosis	Local factors
	Inhaler user
	Acute sinusitis
	Systemic factors
	Uncontrolled diabetes
	Immunosuppression
	Hematological malignancy
	Hematopoietic stem cell transplantation
	Solid organ transplantation**

*5,**2.

Table 2. Investigations and management performed for mucormycosis and oral candidiasis

Mucormycosis	Investigation
	Radiographic Imaging using CT
	Biopsy
	DNA probes targeting the 18S subunit
	Real time PCR targeting the cytochrome b gene*
	Management
	First line: Anti-fungal therapy using liposomal amphotericin B, amphotericin B lipid complex.
	Second line: Posaconazole along with combination therapy of caspofungin and liposomal amphotericin B/ amphotericin B lipid complex**
	Radical resection may include partial to total maxillectomy*
Oralcandidiasis	Investigation
	Exfoliative cytology, potassium peroxide staining, imprint specimen for microbiology culture, culture analysis, salivary assays and oral mucosal biopsy***
	Management
	200 mg fluconazole tablets are given initially followed by 100–200 mg daily for 1–2 weeks.****
	Nystatin oral suspension 100,000 IU/ml as oral rinse and can be discontinued after 48 hours. ****

*4, **3, ***11, ****15

Figure 1. Gram stain shows budding yeast like cells with pseudo hyphae along with few epithelial cells, no pus cells, numerous Gram-negative rods and Gram-positive cocci in pairs

Figure 2. Aseptate hyaline broad branching hyphae on KOH wet mount smear for mucormycosis; site-nasal cavity

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