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LETTER TO EDITOR
Year : 2021  |  Volume : 5  |  Issue : 2  |  Page : 80

Complicating mucormycosis, additional treatment options


Senior Consultant Chest Physician, Waterfront at Sea, Valkenburg ZH, The, Netherlands

Date of Submission03-Aug-2021
Date of Acceptance05-Sep-2021
Date of Web Publication09-Dec-2021

Correspondence Address:
Dr. Ed J van Hezik
Senior Consultant Chest Physician, Waterfront at Sea, 2235TD-10 Valkenburg ZH
Netherlands
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aiao.aiao_20_21

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How to cite this article:
van Hezik EJ. Complicating mucormycosis, additional treatment options. Ann Indian Acad Otorhinolaryngol Head Neck Surg 2021;5:80

How to cite this URL:
van Hezik EJ. Complicating mucormycosis, additional treatment options. Ann Indian Acad Otorhinolaryngol Head Neck Surg [serial online] 2021 [cited 2022 Jan 20];5:80. Available from: https://www.aiaohns.in/text.asp?2021/5/2/80/332065



Sir,

The increasing rate of mucormycosis during the COVID pandemic is a major problem in India, which urgently needs improvement in treatment, according to a recent editorial.[1]

Based on the demonstrated in vitro antifungal activity of cysteine or its derivatives,[2] this may provide a concept or a treatment perspective. Just as amphotericin gains enhanced penetrative power in the inflammatory process with necrotic residues through the liposomes, so does the penetration of cysteine and its derivatives may play a beneficial contributing role in the treatment of mucormycosis. Between the two, N-acetylcysteine (NAC) has less toxicity compared to cysteine with also easier oral, intravenous or topical application (rinsing). It is important to realize that completely new insights into NAC have now been developed. Conventionally, NAC has been viewed as a grab bag that would exhibit ad libitum actions as (i) a reducing agent of disulfide bonds, (ii) a scavenger of reactive oxygen species, and/or (iii) a precursor for glutathione biosynthesis.

At the time, a series of assumptions were made that were not always well substantiated. However, recent new insights often unmasked this grab bag as fairy tales and established cysteine and its derivative NAC as a donor of H2S and a sulfhane sulfur (the latter as the actual antioxidant).[3],[4],[5]

H2S, which is not only known as an effective antiviral and anti-inflammatory agent (Casola, in 3) now with more than 3 dozen excellent results in severe COVID-19, also significantly inhibits the growth of various fungi, including Rhizopus oryzae.[6],[7] High-dose NAC is very safe, with no side effects and cheap. The standard treatment for mucormycosis consists of long-term intravenous liposomal amphotericin B or Posaconazole, euglycemia, and immediate surgical debridement. This could be extended with NAC as an endogenous H2S donor. In this matter, clinical RC studies are warranted.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Panda NK. From the pen of editor in chief. Ann Indian Acad Otorhinolaryngol Head Neck Surg 2021;5:1.  Back to cited text no. 1
  [Full text]  
2.
Galgóczy L, Kovács L, Krizsán K, Papp T, Vágvölgyi C. Inhibitory effects of cysteine and cysteine derivatives on germination of sporangiospores and hyphal growth of different zygomycetes. Mycopathologia 2009;168:125-34.  Back to cited text no. 2
    
3.
Bourgonje AR, Offringa AK, van Eijk LE, Abdulle AE, Hillebrands JL, van der Voort PH, et al. N-acetylcysteine and hydrogen sulfide in coronavirus disease 2019. Antioxid Redox Signal 2021. Advance online publication. [doi: 10.1089/ars.2020.8247].  Back to cited text no. 3
    
4.
van Hezik EJ. N-acetylcysteine: A convenient rationale for COVID-19. Consideration of antiviral H2S for inclusion in one of the ANTICOV or WHO master protocol. AIJR 2021. DOI: https://doi.org/10.21467/preprints.29.  Back to cited text no. 4
    
5.
Pedre B, Barayeu U, Ezeriņa D, Dick TP. The mechanism of action of N-acetylcysteine (NAC): The emerging role of H2S and sulfane sulfur species. Pharmacol Ther 2021;228:107916. Epub ahead of print.  Back to cited text no. 5
    
6.
Fu LH, Hu KD, Hu LY, Li YH, Hu LB, Yan H, et al. An antifungal role of hydrogen sulfide on the postharvest pathogens Aspergillus niger and Penicillium italicum. PLoS One 2014;9:e104206.  Back to cited text no. 6
    
7.
Tang J, Hu KD, Hu LY, Li YH, Liu YS, Zhang H. Hydrogen sulfide acts as a fungicide to alleviate senescence and decay in fresh-cut sweetpotato. HortScience 2014;49:938-43.  Back to cited text no. 7
    




 

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