Risk factors associated with the mucormycosis epidemic during the COVID-19 pandemic

Abstract

This study assessed the risk factors driving the epidemic of COVID-19 associated mucormycosis (COVID-Mucor) in Indiathat accompanied the COVID-19 pandemic, particularly the second wave. We analysed the risk factors among 164 participants:132 COVID-Mucor(cases) and 32 non-COVID-Mucor(controls)using the data from a prospective cohort study of mucormycosis over oneyear. Diabetes mellitus remained a pivotal risk factor in both groups (97%) while uncontrolled diabetes mellitus (OR: 4.6; p=0.026)and newly detected diabetes (OR: 3.3; p=0.018), werecommoneramong the cases. Most patients with COVID-Mucor had mild COVID-19. Steroid use, often unwarranted, was highly associated with COVID-Mucorafter adjusting for other risk factors (OR 28.4; P 0.001). Serum ferritin was significantly higher(p=0.041), while C-reactive protein was not, suggesting that alterations in iron metabolism probably predispose to COVID-Mucor. Oxygen was used only in a small minority of patients with COVID-Mucor. The in-hospital mortality in both groups was low. In conclusion, the Indian COVID-Mucorepidemic was likely driven by a convergence of interlinked risk factors –uncontrolled diabetes mellitus, unwarranted steroid use, and perhapsCOVID-19 itself. Appropriate steroid use in patients with severe COVID-19 and screening and optimal control of hyperglycaemia can prevent COVID-Mucor.

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

“…According to Bhanuprasad et al, the mean age of mucormycosis patient was 51 years, 78% were male and 22% were female [ 17 ]. According to Patel et al, 74.6% of mucormycosis patients were men [ 18 ].…”

“…According to Bhanuprasad, diabetes mellitus remained a significant risk factor in mucormycosis patients with and without COVID-19 infection. 97% mucormycosis patients had underlying diabetes mellitus [ 17 ].…”

“…According to Bhanuprasad, 71.6% patients of mucormycosis had received steroids. Unwarranted steroid use even in mild COVID-19 along with other factors was responsible for the mucor epidemic in India [ 17 ]. According to Sarkar et al, a history of corticosteroid intake for the treatment of COVID-19 was present in 76.3% of cases with mucormycosis [ 21 ].…”

“…According to Bhanuprasad, oxygen use was uncommon among mucormycosis cases [ 17 ]. In the present study, oxygen was given in 54.7% of patients with mucormycosis.…”

Mucormycosis in COVID-19 patients: predisposing factors, prevention and management

“…An interrupted time series analyses of sales volumes of antibiotics in India estimated that COVID-19 likely contributed to 216.4 million excess doses of antibiotics and 38.0 million excess doses of azithromycin until the peak of the first pandemic wave [47]. Chronic antibiotic use by itself is a risk factor for opportunistic fungal infections including mucormycosis and irrational use can result in emergence of antimicrobial resistance [48]. A study performed at a tertiary care center in South India compared the risk factors among CAM and non-COVID mucor patients.…”