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COVID-19-associated mucormycosis in India: Why such an outbreak?
1University of Montpellier, CNRS, IRD, Academic Hospital (CHU) of Montpellier, MiVEGEC, Department of Parasitology/Mycology, Département de Parasitologie-Mycologie, CHU de Montpellier, Site Antonin BALMES/La Colombiere, 39 avenue Charles FLAHAULT - 34295 Montpellier Cedex 5, Tel Laboratoire Hospitalier, Montpellier, France.
Abstract:
An unprecedented mucormycosis outbreak occurred in India during the second COVID-19 wave in spring 2021. COVID-19-associated mucormycosis (CAM) was observed, mainly rhino-orbito-cerebral mucormycosis (ROCM), in patients with poorly controlled diabetes and treated with inappropriate doses of glucocorticoids. The aim of this mini-review was to compare the characteristics of the CAM epidemic in India with (i) mucormycosis cases before the COVID-19 pandemic and (ii) CAM in the rest of the world (particularly in France) in order to identify the reasons for this outbreak. In India, the major mucormycosis epidemiologic change during the COVID-19 pandemic was an increase in the percentage of patients treated with corticosteroids who developed CAM. Compared with the rest of the world, India reported a higher mucormycosis incidence even before the COVID-19 pandemic. Moreover, in India, patients with CAM were more likely to have diabetes mellitus and ROCM; conversely, mortality rates were lower. The reasons for such a localized epidemic in India have remained unclear, but some hypotheses can be put forward, particularly the combination of high prevalence of uncontrolled diabetes mellitus and frequent indiscriminate corticosteroid utilization in a country that already had a high mucormycosis burden before the COVID-19 pandemic.
Insights
An unprecedented mucormycosis outbreak in India during COVID-19 was linked to uncontrolled diabetes and steroid use. This review compares India
Area of Science:
- Infectious Diseases
- Epidemiology
- Mycology
Background:
- An unusual surge in mucormycosis cases, termed COVID-19-associated mucormycosis (CAM), was observed in India during the second COVID-19 wave.
- CAM primarily manifested as rhino-orbito-cerebral mucormycosis (ROCM), particularly in patients with poorly controlled diabetes and those treated with glucocorticoids.
Purpose of the Study:
- To compare the characteristics of the CAM epidemic in India with pre-pandemic mucormycosis cases and global CAM cases.
- To investigate potential reasons behind the localized CAM outbreak in India.
Main Methods:
- Mini-review comparing epidemiological data of mucormycosis in India before and during the COVID-19 pandemic.
- Comparison of Indian CAM cases with international (particularly French) CAM cases.
- Analysis of patient demographics, comorbidities (diabetes mellitus), treatment (corticosteroids), and clinical presentation (ROCM).
Main Results:
- India experienced a higher incidence of mucormycosis even before the COVID-19 pandemic.
- During the pandemic, a significant increase in the proportion of corticosteroid-treated patients developing CAM was noted in India.
- Indian CAM patients were more frequently diagnosed with diabetes mellitus and ROCM, but exhibited lower mortality rates compared to global data.
Conclusions:
- The localized CAM epidemic in India is likely multifactorial, involving a high prevalence of uncontrolled diabetes mellitus.
- Indiscriminate corticosteroid use, coupled with India's pre-existing high burden of mucormycosis, may have contributed to the outbreak.
- Further research is needed to fully elucidate the specific factors driving this epidemic.
