Covid-19 and Mucormycosis Superinfection

Abstract

Background: Mucormycosis (MCR) has been increasingly described in patients with coronavirus disease 2019 (COVID-19), but the epidemiological factors, neurological presentation, and outcome of such patients are not well described. Aims: To study the patient demographics, presenting symptoms and signs, the role of co-morbidities, medications used to treat COVID-19, and the outcomes of management and to study the spectrum of neuraxis involvement and its outcome. Methods: It was a prospective, observational, cross-sectional hospital-based single center cohort study. Confirmed MCR cases with and without COVID-19 were collected. The study was carried out over a period of 3 months from May to July 2021, followed by 3-month follow-up. Information on epidemiological factors, neurological findings, treatment (including medical and surgical treatment), and outcome was recorded. Results: A total of 141 patients were diagnosed with MCR, out of which 98 were COVID-associated MCR (CAM). The CAM incidence was 0.39% among COVID-19-positive patients. The MCR case fatality rate at 90 days was 43.9% but was higher for CAM than for non-CAM patients. Older ages (>50 years), diabetes mellitus, multiple risk factors, diabetic ketoacidosis on admission, brain involvement, and history of COVID-19 pneumonitis were associated with a higher risk for death. Conclusions: Possibly because of improper usage of corticosteroids, zinc, oxygen, and tocilizumab, there was sudden surge of cases of MCR in the COVID-19 pandemic. Therefore, treating physicians should use the COVID-19 pneumonia regimen judiciously. Neurological involvement itself is a poor prognostic sign, but combined surgical and medical management exhibited better outcome.

COVID-19-Associated Mucormycosis

“…There have been many reports of neurological manifestations of CAM[ 1 2 ] including one in this issue of Annals of Indian Academy of Neurology. [ 5 ]…”

“…Other known factors such as immunosuppressive therapy, underlying malignancy, chemotherapy, organ transplant, and chronic kidney disease were also seen in the studies. [ 5 10 ] Two different case-control studies have shown that use of aspirin and anti-coagulation and zinc therapy were associated with a decrease in the risk of CAM. [ 8 9 ]…”

“…These complications have also been reported with CAM. [ 1 2 4 5 11 ] Because the patient who has presented with facial pain, nasal discharge, proptosis, and vision loss can develop additional neurological complications any time during the course of illness, a high level of vigilance is needed to detect them early. Whether CAM has more neurological involvement compared to non-CAM cases has not been looked at in detail.…”

“…In their article, Garg et al . [ 5 ] have described neurological manifestations more than twice in CAM versus non-CAM patients. Strokes were seen in >10% of CAM in our studies.…”

COVID-19-Associated Mucormycosis

“…Two articles published in Jan-Feb 2022 and one in the current issue of the journal have tried to explore this mystery. [ 4 5 6 ] The estimated prevalence of mucormycosis in India is 70 times more than the global prevalence, particularly in the states of Gujarat, Maharashtra, and Karnataka. [ 7 8 9 ] Most of these cases are associated with rhinosinusitis involving the eye and/or brain (rhino-orbital/rhino-orbito-cerebral).…”