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Mucormycosis and diabetes in the times of COVID-19: A Mumbai-based observational study
Anupa R A Hinduja1, Rahul R Tambe1, Purshottam A Giri2
1General Medicine, Nanavati Max Superspecialtiy Hospital, Maharashtra, India.
Background:
There is a significant increase in the number of mucormycosis cases in the setting of the coronavirus disease 2019 (COVID-19) pandemic. This study was undertaken to understand the clinical profile of such patients and the risk factors associated with increased mortality of this already deadly infection.
Materials And Methods:
A retrospective observational study was conducted by including microbiologically confirmed cases of mucormycosis with the background of COVID-19 infection (COVID-19-associated mucormycosis [CAM]). Data was segregated into those of survivors versus non-survivors and the two groups were analyzed for various risk factors. Early and late CAM were also compared.
Results:
The case fatality rate was 21.73% (5/23 patients). Case fatality in early CAM was 33.3% versus 9.1% in late CAM. Rhino-orbital-cerebral mucormycosis (P = 0.01) and cranial nerve involvement (P = 0.0482) were associated with increased mortality. Diabetes and poor glycemic control were the common factors in all patients. Early CAM patients were more likely to have orbital or cerebral involvement (P = 0.0065). Patients having chronic liver disease had a higher risk of mortality (P = 0.0395). Sequential treatment or concurrent dual drug therapy with a combination of antifungal drugs was independently associated with better survival (P = 0.0395). The average duration of treatment with amphotericin-b required for cure by survivors was 29.05 ± 17.05 days. The average duration of treatment with isavuconazole/posaconazole for survivors was 50.32 ± 25.23 days.
Conclusion:
Early CAM had a higher case fatality rate. Patients had better recovery rates with sequential or dual antifungal treatment. The raised incidence and mortality in the COVID-19 pandemic is probably related to the COVID-19-induced immunosuppression with associated diabetes and excessive use of steroids.
Insights
COVID-19-associated mucormycosis (CAM) has a high fatality rate, especially in early-stage cases. Combination antifungal therapy improves survival, suggesting COVID-19-induced immunosuppression and steroid use are key risk factors.
Area of Science:
- Infectious Diseases
- Mycology
- Epidemiology
Background:
- The COVID-19 pandemic has seen a significant rise in mucormycosis cases.
- Mucormycosis is a deadly fungal infection, and its incidence increased during the pandemic.
Purpose of the Study:
- To investigate the clinical characteristics of COVID-19-associated mucormycosis (CAM).
- To identify risk factors associated with increased mortality in CAM patients.
Main Methods:
- A retrospective observational study of microbiologically confirmed CAM cases.
- Data was analyzed comparing survivors and non-survivors, and early versus late CAM presentations.
Main Results:
- The overall case fatality rate was 21.73%. Early CAM had a higher fatality rate (33.3%) than late CAM (9.1%).
- Rhino-orbital-cerebral involvement, cranial nerve palsies, and chronic liver disease were linked to higher mortality. Diabetes and poor glycemic control were common in all patients.
- Sequential or dual antifungal drug therapy was associated with better survival.
Conclusions:
- Early diagnosis and treatment of CAM are crucial due to higher fatality rates.
- Combination antifungal strategies improve patient outcomes.
- COVID-19-induced immunosuppression, diabetes, and steroid use likely contribute to the increased incidence and mortality of CAM.
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