Risk factors for pulmonary mucormycosis in subjects with diabetes mellitus—A case‐control study

Abstract

Background: Factors associated with pulmonary mucormycosis (PM) among subjects with diabetes mellitus (DM) remain unclear. Following the coronavirus disease (COVID-19)-associated mucormycosis outbreak in India, specific environmental exposures (especially cattle dung exposure) were proposed as possible aetiology. We hypothesized that environmental factors are associated with PM. We compared subjects with DM with (cases) and without PM (controls). Methods:In this case-control study, for each PM case, we included five unmatched diabetic controls (hospital [n = 2], community [n = 3]) without PM. We collected information on demography, COVID-19 infection, glycated haemoglobin% (HbA1c), the type of house (pucca vs. kutcha) where the participants reside, and other environmental factors. The primary exposure tested was cattle dung exposure (CDE; using cattle dung cakes as fuel or cattle handling). We performed a multivariate logistic regression to explore factors associated with PM and report the association as an adjusted odds ratio (OR) with 95% confidence intervals (CI). Results:We enrolled 39 PM cases and 199 controls (hospital [n = 80], community [n = 119]). CDE (OR 0.68, 95% CI [0.14-3.31]; p = 0.63) was not associated with increased PM in DM. We found male sex (OR 4.07,), higher HbA1c

COVID-19, mucormycosis, and the cow: Damned lies!

“…Further, in a recent case-control study, we compared 39 cases of pulmonary mucormycosis in diabetes mellitus with 199 controls with diabetes mellitus (119 from the community and 80 from the hospital) without pulmonary mucormycosis [ 40 ]. We elicited a detailed history of various environmental exposures, including farming practices, place of stay, cattle handling, use of cow-dung cakes as fuel, and several others.…”

Immune and metabolic perturbations in COVID‐19‐associated pulmonary mucormycosis: A transcriptome analysis of innate immune cells

“…It was speculated that changes in the immune landscape due to COVID‐19 or mechanisms seen in influenza‐associated pulmonary aspergillosis (IAPA) might also be operative in the development of mucormycosis post‐COVID‐19 4 . Pulmonary mucormycosis is a life‐threatening opportunistic fungal infection that typically affects immunocompromised patients with haematological malignancies or neutropenia 5,6 . The clinical presentation ranges from acute to subacute, depending on the host's immune status, with a mortality rate of 57.1% 7 .…”

“…The clinical presentation ranges from acute to subacute, depending on the host's immune status, with a mortality rate of 57.1% 7 . The immunological status of patients who develop pulmonary mucormycosis post SARS‐CoV‐2 infection is unclear 6,8 . Few studies from India highlighted the clinical and immunological characteristics observed among CAPM patients 9,10 .…”

“…4 Pulmonary mucormycosis is a life-threatening opportunistic fungal infection that typically affects immunocompromised patients with haematological malignancies or neutropenia. 5,6 The clinical presentation ranges from acute to subacute, depending on the host's immune status, with a mortality rate of 57.1%. 7 The immunological status of patients who develop pulmonary mucormycosis post SARS-CoV-2 infection is unclear.…”

“…7 The immunological status of patients who develop pulmonary mucormycosis post SARS-CoV-2 infection is unclear. 6,8 Few studies from India highlighted the clinical and immunological characteristics observed among CAPM patients. 9,10 In a pan-India case-control study, several previously known host factors, such as organ transplantation, diabetes mellitus and immunosuppression, were implicated in CAPM.…”