Mucormycosis in COVID-19 pandemic: study at tertiary hospital in India

Abstract

Aim During the second wave of COVID-19, cases of mucormycosis were increased suddenly over a period of 3 months in Maharashtra, India. An attempt was made to study the clinical profile and risk factors associated with mucormycosis. Materials and methods A retrospective descriptive study was carried out at a tertiary hospital during May 2021–July 2021. After obtaining informed written consent from the participants, various details of all participants, such as diabetes mellitus, use of steroids in COVID-19 treatment, use of immunosuppressant drugs, oxygen therapy, use of ventilators, complications that occurred during treatment, etc., were noted. All mucormycosis patients were treated with amphotericin B and aggressive surgical treatment. Results In the present study, 74.7% of mucormycosis patients were male. 77.4% of mucormycosis patients were above 40 years of age. 6.7% of mucormycosis patients were partially vaccinated. Among risk factors, 86.6% had diabetes mellitus, 84% had COVID-19 infection, 44% had received steroids, and 54.7% had received oxygen. 80% of patients were present during and within 1 month of COVID-19 infection. 52% of patients were presented in stage III and 41.3% were presented in stage II. Despite aggressive surgical debridement along with amphotericin B, mortality was 25.33%. 5.3% of patients had brain abscesses, 8% of patients had cavernous sinus thrombosis, 4% of patients had facial nerve palsy and 1.3% of patients had meningitis. Conclusion Mucormycosis was predominantly seen in male above the age of 40 years COVID-19 infection and diabetes mellitus was common risk factor for mucormycosis.

Mucormycosis, New Causative Agents, and New Susceptible Populations: Review of Cases in a Tertiary Care Hospital in Iran (2007-2021)

“…Among the risk factors, diabetes mellitus, contracting COVID-19, and steroid use were the most common risk factors, and mortality was 25.33%. 5.3% of patients had brain abscesses, 8% of patients had cavernous sinus thrombosis, 4% of patients had facial nerve palsy, and 1.3% of patients had meningitis ( 20 ).…”

Epidemiology of COVID-19–Associated Mucormycosis

“…CNS involvement associated with risk of mortality Rao K, Pooja N [ 99 ] Observational study from ENT clinic, single center, India 180 40-60 years 78% male ROCM 100% 75.6% smear positive 100% 77.8% of patients were post-COVID 19 infections, severity of COVID-19 not reported Steroid use is not reported 76% 16% Most common risk factor was diabetes, patients who underwent medical and surgical management had better outcomes Choksi T, Agrawal A, Date P et al [ 34 ] Single center case control study, India 3/2021-5/2021 73 CAM patients 53.5 66% male ROCM 100% 74% All patients were post-COVID-19 infection, severity not reported of COVID-19 not reported 98% 45% 36% died within 10 days of admission. Cumulative probability of death 53% at day 21 NIV or mechanical ventilation inc risk of mortality (a OR 8.98, 2.1-38.6) and light perception dec risk of mortality (aOR 0.56, 0.32-0.98) at 40 days Chavan RP, Ingole SM, Nazir et al [ 100 ] Single center retrospective study, India May 2021-Jul 2021 75 CAM patients 77 % over 40 years age, 75% male 100% ROCM CNS involvement 6.7% 86.6% Oxygen requirement 55% 44% received steroids 89% were operated. 25.3% Study the risk factors associated with Mucormycosis infection, age of > 40, COVID-19 infection and DM were the mostcommon RF for Mucormycosis seen in the study Sen M, HOnavar S, Sengupta S et al [ 29 ] Retrospective multicenter observational study with data gathered through ophthalmology providers registry, India 1/2020-5/2021 2826 51.9 71% male ROCM 100% CNS involvement 21% 78%, uncontrolled 41% O2 requirement 56% 87% 80% of pts with no supplemental O2 requirement and 67% of ambulatory patients received corticosteroids.…”

Infectious disease for the rhinologist

“…As a fungal infection unique to the COVID-19 pandemic, particularly in the Indian subcontinent, COVID-19-associated rhino-orbital-cerebral mucormycosis (CA-ROCM) gained attention. High overall mortality rates of up to 25% have been noted even in patients who received multimodal treatment [22]. A systematic review and meta-analysis estimated the in-hospital prevalence of COVID-19 among mucormycosis patients to be as high as 57% [23].…”