COVID-19 associated multisystemic mucormycosis from India: a multicentric retrospective study on clinical profile, predisposing factors, cumulative mortality and factors affecting outcome

Abstract

Purpose The clinical course of COVID-19 has been complicated by secondary infections, including bacterial and fungal infections. The rapid rise in the incidence of invasive mucormycosis in these patients is very much concerning. COVID-19-associated mucormycosis was detected in huge numbers during the second wave of the COVID-19 pandemic in India, with several predisposing factors indicated in its pathogenesis. This study aimed to evaluate the epidemiology, predisposing factor, cumulative mortality and factors affecting outcomes among the coronavirus disease COVID-19-associated mucormycosis (CAM). Methods A multicenter retrospective study across three tertiary health care centers in Southern part of India was conducted during April-June 2021. Results Among the 217 cases of CAM, mucormycosis affecting the nasal sinuses was the commonest, affecting 95 (44%) of the patients, orbital extension seen in 84 (38%), pulmonary ( n = 25, 12%), gastrointestinal ( n = 6, 3%), isolated cerebral ( n = 2) and disseminated mucormycosis ( n = 2). Diabetes mellitus, high-dose systemic steroids were the most common underlying disease among CAM patients. The mucormycosis-associated case-fatality at 6 weeks was 14%, cerebral or GI or disseminated mucormycosis had 9 times higher risk of death compared to other locations. Extensive surgical debridement along with sequential antifungal drug treatment improved the survival in mucormycosis patients. Conclusion Judicious and appropriate management of the predisposing factor and factors affecting mortality associated with CAM with multi-disciplinary approach and timely surgical and medical management can be much helpful in achieving a successful outcome.

Incidence and Mortality of COVID-19-Associated Invasive Fungal Infections Among Critically Ill Intubated Patients: A Multicenter Retrospective Cohort Analysis

“…COVID-19-associated mucormycosis first became prominent with the Delta wave in India [ 41 ]. In previous case series with mostly patients diagnosed in India, mucormycosis has been associated with higher crude mortality [ 17 , 42–44 ]. To our knowledge, our analysis is one of the few to assess mortality for this infection by comparing it with a control group and adjusting for potential confounders.…”

The Study of Clinical Profile of Patients With Mucormycosis During COVID-19 Pandemic in Tertiary Care Hospital

“…Notably, proptosis was the primary symptom among those with orbital involvement (n = 68, 39%), while 53(30%) patients experienced either blurred vision or substantial vision loss. For those with pulmonary involvement (n = 25), all cases presented with cough and dyspnea (100%), with 80% reporting chest pain and 35% experiencing hemoptysis [22].…”

Infectious disease for the rhinologist

“…While many theories are proposed regarding the etiology of CA-ROCM, including SARS-CoV-2, diabetes mellitus, immunocompromise and thromboembolic phenomena [24], it is likely to be multifactorial and thus difficult to pinpoint any singular cause. Studies evaluating the predisposing factors for COVID-19-associated mucormycosis, including CA-ROCM, identified high-dose systemic steroid use and uncontrolled diabetes as significant factors in the development of the disease [25,26]. It is postulated that the combination of immunosuppression from frequent use of high-dose steroids in COVID-19, on a background of diabetic patients with a hyperglycemia-induced pro-inflammatory state, precipitates the presentation of COVID-19associated mucormycosis and CA-ROCM [26].…”