COVID associated mucormycosis: A preliminary study from a dedicated COVID Hospital in Delhi

Abstract

Background It is an incontrovertible fact that the Rhino Orbital Cerebral Mucormycosis (ROCM) upsurge is being seen in the context of COVID-19 in India. Briefly presented is evidence that in patients with uncontrolled diabetes, a dysfunctional immune system due to SARS-COV-2 and injudicious use of corticosteroids may be largely responsible for this malady. Objective To find the possible impact of COVID 19 infection and various co-morbidities on occurrence of ROCM and demonstrate the outcome based on medical and surgical interventions. Methodology. Prospective longitudinal study included patients diagnosed with acute invasive fungal rhinosinusitis after a recent COVID-19 infection. Diagnostic nasal endoscopy (DNE) was performed on each patient and swabs were taken and sent for fungal KOH staining and microscopy. Medical management included Injection Liposomal Amphotericin B, Posaconazole and Voriconazole. Surgical treatment was restricted to patients with RT PCR negative results for COVID-19. Endoscopic, open, and combined approaches were utilized to eradicate infection. Follow-up for survived patients was maintained regularly for the first postoperative month. Results Out of total 131 patients, 111 patients had prior history of SARS COVID 19 infection, confirmed with a positive RT-PCR report and the rest 20 patients had no such history. Steroids were received as a part of treatment in 67 patients infected with COVID 19. Among 131 patients, 124 recovered, 1 worsened and 6 died. Out of 101 known diabetics, 98 recovered and 3 had fatal outcomes. 7 patients with previous history of COVID infection did not have any evidence of Diabetes mellitus, steroid intake or any other comorbidity. Conclusion It can be concluded that ROCM upsurge seen in the context of COVID-19 in India was mainly seen in patients with uncontrolled diabetes, a dysfunctional immune system due to SARS-COV-2 infection and injudicious use of corticosteroids.

Clinical Features and Mortality of COVID-19-Associated Mucormycosis: A Systematic Review and Meta-Analysis

“…[ 47 ] India Retrospective Single-center 11 Feb 2020–May 2021 47 ± 11 100 (11) 64 (7) Fouad YA. [ 48 ] Egypt Retrospective Single-center 26 Apr 2021–Aug 2021 63 [46–70] 54 (14) 96 (25) Meher R. [ 49 ] Iran Prospective Single-center 111 May 2021–Jun 2021 53 ± 12 70 (78) 94 (104) Guzman-Castro S. [ 50 ] UK Retrospective Single-center 6 May 2021 52 [45–57] 83 (5) 83 (5) Kumar H. [ 51 ] India Retrospective Single-center 28 Apr 2021–May 2021 54 [48–59] 79 (22) 75 (21) Yadav T. [ 52 ] India Retrospective Single-center 50 Dec 2020–Jun 2021 50 [28–70] 62 (31) 86 (43) Meshram HS. [ 53 ] India Retrospective …”

“…[ 47 ] 45 (5) 100 (11) 100 (11) – 36 (4) 0 (0) 36 (4) – Fouad YA. [ 48 ] 27 (7) 12 (3) – – – – 77 (20) – Meher R. [ 49 ] – – – – 27 (30) 5.4 (6) 60 (67) 5.4 (6) Guzman-Castro S. [ 50 ] – – – – 50 (3) 33 (2) 100 (6) – Kumar H. [ 51 ] – – – – 57 (16) 21 (6) 68 (19) – Yadav T. [ 52 ] – – 2.0 (1) – 38 (19) – 44 (22) – Meshram HS. [ 53 ] – 100 (61) 100 (61) – 67 (41) 0 (0) …”

COVID-19 associated rhino–orbital–cerebral mucormycosis—an institutional series

“… 18 Another indirect potential correlation has been established between COVID-19 and mucormycosis in India is the use of contaminated water with fungal spores for oxygen humidifier or use of contaminated and poor quality industrial oxygen during the shortfall of medical oxygen during the second wave of COVID-19 infection. 19 …”

Fungal Infections in Critically Ill COVID-19 Patients: Inevitabile Malum

“…The authors suggested that their data should be compared to data from Western countries, where the main predisposing factor for mucormycosis are hematological malignancies and organ transplantation, apart from diabetes mellitus. Several other cohorts reported the frequency of GCS use among CAM patients as high as 60% [ 104 , 105 ], over 85% [ 106 , 107 ] and 100% [ 107 ]. With regards to Pneumocystis jirovecii Pneumonia (PJP), Chong et al [ 108 ], in their excellent review of PJP-SARS-CoV-2 co-infection case reports, conclude that the virus may predispose to this fungal entity through lymphocytopenia and macrophage dysfunction.…”