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Risk factors for pulmonary mucormycosis in subjects with diabetes mellitus-A case-control study
Deepak Garg1, Kathirvel Soundappan2, Ritesh Agarwal3
1Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Background:
Factors associated with pulmonary mucormycosis (PM) among subjects with diabetes mellitus (DM) remain unclear. Following the coronavirus disease (COVID-19)-associated mucormycosis outbreak in India, specific environmental exposures (especially cattle dung exposure) were proposed as possible aetiology. We hypothesized that environmental factors are associated with PM. We compared subjects with DM with (cases) and without PM (controls).
Methods:
In this case-control study, for each PM case, we included five unmatched diabetic controls (hospital [n = 2], community [n = 3]) without PM. We collected information on demography, COVID-19 infection, glycated haemoglobin% (HbA1c), the type of house (pucca vs. kutcha) where the participants reside, and other environmental factors. The primary exposure tested was cattle dung exposure (CDE; using cattle dung cakes as fuel or cattle handling). We performed a multivariate logistic regression to explore factors associated with PM and report the association as an adjusted odds ratio (OR) with 95% confidence intervals (CI).
Results:
We enrolled 39 PM cases and 199 controls (hospital [n = 80], community [n = 119]). CDE (OR 0.68, 95% CI [0.14-3.31]; p = 0.63) was not associated with increased PM in DM. We found male sex (OR 4.07, 95% CI [1.16-14.31]), higher HbA1c (OR 1.51, 95% CI [1.18-16.32]), COVID-19 (OR 28.25, 95% CI [7.02-113.6]) and residence at kutcha house (OR 4.84, 95% CI [1.33-17.52]) associated with PM.
Conclusion:
Cattle dung exposure was not associated with PM in subjects with DM. Instead, male sex, poor glycaemic control, COVID-19 and the type of housing were associated with pulmonary mucormycosis.
Insights
Pulmonary mucormycosis (PM) in diabetes mellitus (DM) is not linked to cattle dung exposure. Instead, male sex, high HbA1c, COVID-19, and kutcha housing increase PM risk.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Epidemiology
Background:
- Pulmonary mucormycosis (PM) is a serious fungal infection, particularly concerning in individuals with diabetes mellitus (DM).
- The association between environmental factors, such as cattle dung exposure (CDE), and PM in DM patients remains poorly understood, especially following the COVID-19 pandemic.
- This study investigated potential environmental and clinical risk factors for PM in diabetic patients.
Purpose of the Study:
- To identify factors associated with pulmonary mucormycosis (PM) in patients with diabetes mellitus (DM).
- To investigate the role of environmental exposures, specifically cattle dung exposure (CDE), in the development of PM among DM patients.
- To compare risk factors between diabetic patients with and without PM.
Main Methods:
- A case-control study design was employed, comparing 39 PM cases with 199 diabetic controls without PM.
- Data collected included demographics, COVID-19 infection history, glycated hemoglobin (HbA1c) levels, housing type (pucca vs. kutcha), and environmental exposures, with a focus on CDE.
- Multivariate logistic regression analysis was used to determine factors associated with PM, reporting adjusted odds ratios (OR) and 95% confidence intervals (CI).
Main Results:
- Cattle dung exposure (CDE) was not found to be associated with an increased risk of PM in diabetic patients (OR 0.68, 95% CI [0.14-3.31]).
- Factors significantly associated with increased risk of PM included male sex (OR 4.07), higher HbA1c levels (OR 1.51), a history of COVID-19 infection (OR 28.25), and residing in a kutcha house (OR 4.84).
Conclusions:
- Cattle dung exposure is not a significant risk factor for pulmonary mucormycosis in individuals with diabetes mellitus.
- Male sex, poor glycemic control (higher HbA1c), prior COVID-19 infection, and living in less robust housing (kutcha houses) are identified as key risk factors for PM in this population.
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