Study to Identify the Risk Factors and their Relationship with Mucormycosis Severity in COVID Pneumonia

Abstract

Background: Mucormycosis is an infection caused by a fungus that is present naturally in the environment. There has been an increased number of mucormycosis infections reported during COVID-19 and post COVID period. Dysregulated immune system due to COVID-19 and steroid use in the treatment which suppresses the immune system predisposes to this fungal infection. Patients with Diabetes Mellitus & those who receive humidified oxygen during COVID-19 are found to be at higher risk of developing mucormycosis.
 Methodology: 60 patients with mucormycosis admitted in the mucormycosis ward of SVRRGGH, Tirupathi, Andhra Pradesh, India in June 2021 are enrolled and retrospectively studied. Data were collected according to prestructured proforma about risk factors which include the previous history of Diabetes, CT severity score during COVID-19, and use of steroids and oxygen during the period of COVID-19.
 Results: A total of 60 patients with mucormycosis were included in the study with a mean age of 49.25+/-10.29. 80% of the patients were males & 20% were females. 38.33% had mild COVID-19 (CTSS 0-7), 45% had moderate disease (CTSS 8-17) and 16.66% had severe disease (CTSS 18-25). 70% had stage 2, 18.33% had stage 3 and 10% had stage 4 mucormycosis. Out of total patients, 78.33% were found to have a previous history of diabetes or newly detected diabetes. 60% of the patients had a history of humidified oxygen inhalation & 58.33% of the patients had received steroids during COVID-19.
 Conclusion: Male preponderance was observed in the study. Diabetes Mellitus, steroid use, humidified oxygen usage are the identifiable risk factors in mucormycosis associated with COVID-19. CT severity score is directly proportional to mucormycosis severity in the present study.

Estimation of triple prognostic factors: serum ferritin, D-dimer and HbA1c levels in post-COVID mucormycosis patients: a cross-sectional observational study

“…Similar results were found in study of Lenus et al in which 60% and in study of Goddanti et al 60% of patients had a history of oxygen usage during the period of COVID-19. 10,14 Improper sanitization of oxygen cylinders, lack of clean and distilled water in oxygen humidifiers, overuse of steam inhalation and humidified oxygen were put forth as some the possible precipitating factors for CAM.…”

Mucormycosis in a case of multisystem inflammatory syndrome in children (MIS-C): “double trouble”: a case report

“…Mucormycosis is a serious fungal infection formed as a result of improper neutrophilic response in the body. This is most commonly seen in immunocompromised children or in children with long term steroid usage, malnutrition and organ transplant recipients [ 8 ]. Patients with breaks in continuity of skin are at higher risk to develop cutaneous mucormycosis.…”

Profiling of mucormycosis in district of central rural India during COVID-19 pandemic: a record-based study

“…4 Although rhinoorbitocerebral mucormycosis (ROCM) is the most prevalent form observed in clinical practise globally, mucormycosis can affect the nose, sinuses, orbit, central nervous system (CNS), lung (pulmonary), gastrointestinal tract (GIT), skin, jaw bones, joints, heart, and mediastinum (invasive kind). 5 Invasive mucormycosis cases have increased as a result of the widespread use of voriconazole for prevention or treatment of aspergillosis in individuals with haematological malignancies. Patients who have high iron serum concentrations as well as phagocytic dysfunctions brought on by neutropenia or ketoacidosis are more likely to develop mucormycosis.…”