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| LETTER TO EDITOR |
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| Year : 2021 | Volume
: 5
| Issue : 2 | Page : 80 |
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Complicating mucormycosis, additional treatment options
Ed J van Hezik
Senior Consultant Chest Physician, Waterfront at Sea, Valkenburg ZH, The, Netherlands
| Date of Submission | 03-Aug-2021 |
| Date of Acceptance | 05-Sep-2021 |
| Date of Web Publication | 09-Dec-2021 |
Correspondence Address:
Dr. Ed J van Hezik
Senior Consultant Chest Physician, Waterfront at Sea, 2235TD-10 Valkenburg ZH
Netherlands
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/aiao.aiao_20_21
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 Sep 28];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 | |  |
| 1. | Panda NK. From the pen of editor in chief. Ann Indian Acad Otorhinolaryngol Head Neck Surg 2021;5:1.  [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. |
| 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]. |
| 4. | van Hezik EJ. N-acetylcysteine: A convenient rationale for COVID-19. Consideration of antiviral H 2S for inclusion in one of the ANTICOV or WHO master protocol. AIJR 2021. DOI: https://doi.org/10.21467/preprints.29. |
| 5. | Pedre B, Barayeu U, Ezeriņa D, Dick TP. The mechanism of action of N-acetylcysteine (NAC): The emerging role of H 2S and sulfane sulfur species. Pharmacol Ther 2021;228:107916. Epub ahead of print. |
| 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. |
| 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. |
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