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Published on: July 30, 2017
COVID-19 associated multisystemic mucormycosis from India: a multicentric retrospective study on clinical profile,
Monalisa Sahu1, Milap Shah2, Venkateswara R Mallela3
1Department of Infectious Diseases, Yashoda Hospital, Secunderabad, Hyderabad, 500003, India. dr.monalisaaiims@gmail.com.
Purpose:
The clinical course of COVID-19 has been complicated by secondary infections, including bacterial and fungal infections. The rapid rise in the incidence of invasive mucormycosis in these patients is very much concerning. COVID-19-associated mucormycosis was detected in huge numbers during the second wave of the COVID-19 pandemic in India, with several predisposing factors indicated in its pathogenesis. This study aimed to evaluate the epidemiology, predisposing factor, cumulative mortality and factors affecting outcomes among the coronavirus disease COVID-19-associated mucormycosis (CAM).
Methods:
A multicenter retrospective study across three tertiary health care centers in Southern part of India was conducted during April-June 2021.
Results:
Among the 217 cases of CAM, mucormycosis affecting the nasal sinuses was the commonest, affecting 95 (44%) of the patients, orbital extension seen in 84 (38%), pulmonary (n = 25, 12%), gastrointestinal (n = 6, 3%), isolated cerebral (n = 2) and disseminated mucormycosis (n = 2). Diabetes mellitus, high-dose systemic steroids were the most common underlying disease among CAM patients. The mucormycosis-associated case-fatality at 6 weeks was 14%, cerebral or GI or disseminated mucormycosis had 9 times higher risk of death compared to other locations. Extensive surgical debridement along with sequential antifungal drug treatment improved the survival in mucormycosis patients.
Conclusion:
Judicious and appropriate management of the predisposing factor and factors affecting mortality associated with CAM with multi-disciplinary approach and timely surgical and medical management can be much helpful in achieving a successful outcome.
Insights
COVID-19-associated mucormycosis (CAM) is a serious secondary infection. This study found diabetes and steroid use were key risk factors, with nasal sinus involvement most common and extensive disease increasing mortality risk.
Area of Science:
- Infectious Diseases
- Mycology
- Epidemiology
Background:
- Secondary infections, including invasive fungal infections like mucormycosis, complicate COVID-19 clinical course.
- A significant rise in COVID-19-associated mucormycosis (CAM) cases was observed, particularly during the second wave of the pandemic in India.
- Understanding the epidemiology and predisposing factors of CAM is crucial for patient management.
Purpose of the Study:
- To evaluate the epidemiology of COVID-19-associated mucormycosis (CAM).
- To identify predisposing factors contributing to CAM pathogenesis.
- To determine cumulative mortality and factors influencing outcomes in CAM patients.
Main Methods:
- A multicenter retrospective study was conducted across three tertiary healthcare centers in Southern India.
- Data was collected from patients diagnosed with CAM between April and June 2021.
- Epidemiological data, predisposing factors, treatment, and outcomes were analyzed.
Main Results:
- Out of 217 CAM cases, nasal sinus involvement was most common (44%), followed by orbital extension (38%).
- Diabetes mellitus and high-dose systemic steroid use were the most frequent underlying conditions.
- The 6-week mortality rate was 14%; cerebral, gastrointestinal, or disseminated mucormycosis conferred a 9-fold higher risk of death.
Conclusions:
- Judicious management of predisposing factors is essential for successful CAM outcomes.
- A multidisciplinary approach involving timely surgical and medical management improves survival rates.
- Addressing risk factors and implementing prompt interventions are key to better patient outcomes in CAM.
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