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Risk Factors of COVID-19 Associated Mucormycosis (CAM) in Iranian Patients: A Single-Center Retrospective Study
Soheil Tavakolpour1, Shirin Irani2, Mir Saeed Yekaninejad3
1Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, 02215, USA.
Background:
COVID-19 associated mucormycosis (CAM) has been known as one of the most severe post-COVID morbidities.
Objectives:
To describe CAM cases, identify possible risk factors, and report outcomes of patients.
Methods:
This retrospective study was performed in Amir-Alam Hospital, Tehran, Iran between February 2020 and September 2021. Patients with mucormycosis who had an active or previous diagnosis of COVID-19 have been included.
Results:
Of 94 patients with mucormycosis, 52 (33 men and 19 women; mean age: 57.0 ± 11.82 years) were identified with an active or history of COVID-19. Rhino-orbital, rhino maxillary, rhino-orbito cerebral subtypes of mucormycosis were detected in 6 (11.5%), 18(34.6%), and 28(53.8%) patients. As a control group, 130 (69 men and 61 women; mean age: 53.10 ± 14.49 years) random RT-PCR-confirmed COVID-19 patients without mucormycosis have been included. The mean interval between COVID-19 diagnosis and initial mucormycosis symptoms was 16.63 ± 8.4 days (range 0-51). Those in the CAM group had a significantly more severe course of COVID-19 (OR = 3.60, P-value < 0.01). Known history of previous diabetes mellitus (OR = 7.37, P-value < 0.01), smoking (OR = 4.55, P-value < 0.01), and history of receiving high-dose corticosteroid pulse therapy because of more severe COVID-19 (P-value = 0.022) were found as risk factors. New-onset post-COVID hyperglycemia was lower in the CAM group (46.2% vs. 63.8%; OR = 0.485, P-value = 0.028). After treatment of the CAM group, 41(78.8%) of patients recovered from mucormycosis. The mean ages of the expired patients in the CAM group were significantly higher than those who recovered from mucormycosis (66.18 ± 9.56 vs. 54.56 ± 11.22 years; P < 0.01); and COVID-19 disease was more severe (P = 0.046).
Conclusion:
Either active or history of COVID-19 can cause an increase in the risk of mucormycosis development. Some of the most important risk factors are the medical history of diabetes mellitus, smoking, and high-dose corticosteroid therapy. CAM is important possible comorbidity related to COVID-19, which could make the post-COVID conditions more complicated. More research and studies with greater sample sizes among different ethnicities are needed to explore the association between COVID-19 and mucormycosis.
Insights
COVID-19 associated mucormycosis (CAM) is a severe post-COVID condition. Key risk factors include diabetes, smoking, and corticosteroid use, highlighting the need for further research into this significant comorbidity.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Ophthalmology
Background:
- COVID-19 associated mucormycosis (CAM) represents a severe post-COVID-19 complication.
- Mucormycosis is a serious fungal infection that can affect various parts of the body.
Purpose of the Study:
- To characterize cases of CAM.
- To identify potential risk factors associated with CAM.
- To report patient outcomes following CAM diagnosis and treatment.
Main Methods:
- Retrospective study conducted at Amir-Alam Hospital, Tehran, Iran (February 2020 - September 2021).
- Included patients with mucormycosis and a history of or active COVID-19.
- A control group of COVID-19 patients without mucormycosis was also included for comparison.
Main Results:
- Of 94 mucormycosis patients, 52 had active or prior COVID-19.
- CAM patients experienced more severe COVID-19 (OR=3.60).
- Significant risk factors identified: diabetes mellitus (OR=7.37), smoking (OR=4.55), and high-dose corticosteroid therapy.
- Recovery rate for CAM patients was 78.8%; mortality was higher in older patients and those with more severe COVID-19.
Conclusions:
- Active or past COVID-19 increases mucormycosis risk.
- Diabetes, smoking, and high-dose corticosteroids are key risk factors for CAM.
- CAM is a significant comorbidity that complicates post-COVID-19 recovery, necessitating further research across diverse populations.
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