Published: 2021-08-21

Association of serum interleukin 6 levels with clinical outcome of COVID-19 associated mucormycosis

Ramakrishnan Sivasankaran, Parvathi Mallesh, Prakash Banahalli Chikkaiah, Meer Zuhadulla, Bhavana Bhagvath


Background: Interleukin 6 (IL6) is an inflammatory cytokine and hence used as a serological marker of inflammation. COVID-19 infections induces a state of hyperinflammation which makes it conducive for opportunistic infections like mucormycosis.

Methods: The prospective single-center study considered adults patients of both the gender, diagnosed with COVID-19 infection by RT-PCR technique and clinically, microbiologically or radiologically confirmed cases of mucormycosis. Necessary demographic, clinical data and serum IL6 level were collected and selected subjects were followed up until discharge or death. Subjects were classified as those who survived and succumbed to death. Chi-square test was used to analyse for categorical data between the groups.

Results: The study included 61 subjects, where in there was statistically significant association between serum IL6 levels with clinical outcome of COVID-19 associated mucormycosis (CAM). Serum IL6 levels were significantly higher in patients who died.

Conclusions: Higher serum IL6 levels is associated with poor clinical outcome in patients with CAM. Hence it can be used as a marker to predict prognosis of the disease.


COVID-19, Mucormycosis, Interleukin 6

Full Text:



Shi Z, Hu Z. A review of studies on animal reservoirs of the SARS coronavirus. Virus Res. 2008;133(1):74-87.

Donnelly CA, Ghani AC, Leung GM, Hedley AJ, Fraser C, Riley S, et al. Epidemiological determinants of spread of causal agent of severe acute respiratory syndrome in Hong Kong. Lancet. 2003;361(9371):1761-6.

Cauchemez S, Fraser C, Kerkhove MDV, Donnelly CA, Riley S, Rambaut A, et al. Middle East respiratory syndrome coronavirus: quantification of the extent of the epidemic, surveillance biases, and transmissibility. Lancet Infect Dis. 2014;14(1):50-6.

Wu P, Hao X, Lau EHY, Wong JY, Leung KSM, Wu JT, et al. Real-time tentative assessment of the epidemiological characteristics of novel coronavirus infections in Wuhan, China, as at 22 January 2020. Euro Surveill. 2020;25(3):2000044.

Hamming I, Timens W, Bulthuis ML, Lely AT, Navis G, Van GH. Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus: a first step in understanding SARS pathogenesis. J Pathol. 2004;203(2):631-7.

Mucormycosis: The 'black fungus' maiming COVID patients in India. Available at: js_v=a6&usqp=mq331AQKKAFQArABIIACAw%3D%3D#amp_tf=From%20%251%24s&aoh=16282503593784& Accessed on 20 July 2021.

Lewis RE, Kontoyiannis DP. Epidemiology and treatment of mucormycosis. Future Microbiol. 2013;8(9):1163-75.

Gamaletsou MN, Sipsas NV, Roilides E, Walsh TJ. Rhino-orbital-cerebral mucormycosis. Curr Infect Dis Rep. 2012;14(4):423-34.

Hirano T, Murakami M. COVID-19: a new virus, but a familiar receptor and cytokine release syndrome. Immunity. 2020;52(5):731-3.

Pemán J, Ruiz-Gaitán A, García-Vidal C, Salavert M, Ramírez P, Puchades F, et al. Fungal co-infection in COVID-19 patients: should we be concerned?. Rev Iberoam Micol. 2020;37(2):41-6.

RECOVERY Collaborative Group, Horby P, Lim WS, Emberson JR, Mafham M, Bell JL, et al. Dexamethasone in hospitalized patients with COVID-19. N Engl J Med. 2021;384(8):693-704.

Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507-13.

Gangneux JP, Bougnoux ME, Dannaoui E, Cornet M, Zahar JR. Invasive fungal diseases during COVID-19: we should be prepared. J Mycol Med. 2020;30(2):100971.

Pasero D, Sanna S, Liperi C, Piredda D, Branca GP, Casadio L, et al. A challenging complication following SARS-CoV-2 infection: a case of pulmonary mucormycosis. Infection. 2020;1-6.

Baldin C, Ibrahim AS. Molecular mechanisms of mucormycosis-the bitter and the sweet. PLoS Pathog. 2017;13(8):1006408.

Jose A, Singh S, Roychoudhury A, Kholakiya Y, Arya S, Roychoudhury S. Current understanding in the pathophysiology of SARS-CoV-2-associated rhino-orbito-cerebral mucormycosis: a comprehensive review. J Maxillofac Oral Surg. 2021:1-8.

Pal R, Bhadada SK. COVID-19 and diabetes mellitus: an unholy interaction of two pandemics. Diabet Metabol Syndr Clinic Res Rev. 2020;14(4):513-7.

John TM, Jacob CN, Kontoyiannis DP. When uncontrolled diabetes mellitus and severe COVID-19 converge: the perfect storm for mucormycosis. J Fungi (Basel). 2021;7(4):298.

Alba-Loureiro TC, Munhoz CD, Martins JO, Cerchiaro GA, Scavone C, Curi R, et al. Neutrophil function and metabolism in individuals with diabetes mellitus. Braz J Med Biol Res. 2007;40(8):1037-44.

Hirano T, Murakami M. COVID-19: a new virus, but a familiar receptor and cytokine release syndrome. Immunity. 2020;52(5):731-3.