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Clinical Challenges and Predictive Risk Factors for Outcomes in COVID-19-Associated Mucormycosis.

Fardin Ahmadkhani1, Seyed Jamal Hashemi1, Roshanak Daei Ghazvini1

  • 1Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

Iranian Journal of Pathology
|August 1, 2025
PubMed
Summary

COVID-19-associated mucormycosis (CAM) is severe, especially with uncontrolled diabetes and corticosteroid use. Disease spread to the orbit and CNS significantly increases mortality, highlighting the need for early diagnosis and intervention.

Keywords:
COVID-19Central Nervous SystemDiabetes MellitusMortalityMucormycosisRisk Factors

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Area of Science:

  • Infectious Diseases
  • Ophthalmology
  • Neurology
  • Critical Care Medicine

Background:

  • Mucormycosis is a severe complication in COVID-19 patients, particularly those with uncontrolled diabetes and on corticosteroid therapy.
  • This fungal infection can spread from sinuses to the orbit and central nervous system (CNS), increasing morbidity and mortality.
  • Understanding risk factors for severe COVID-19-associated mucormycosis (CAM) is crucial.

Purpose of the Study:

  • To identify clinical risk factors for severe COVID-19-associated mucormycosis (CAM).
  • To determine outcomes associated with disease severity and mortality in CAM.
  • To focus on disease progression to orbital and central nervous system (CNS) involvement.

Main Methods:

  • 180 confirmed CAM patients were enrolled and classified by disease extent: sinus-only, sinus with orbital, and sinus with orbital and CNS involvement.
  • Data collected included demographics, clinical history, laboratory findings, imaging, treatment, and outcomes.
  • Statistical analysis identified associations between risk factors, disease progression, and outcomes.

Main Results:

  • Uncontrolled diabetes (38%) and corticosteroid use were significantly associated with severe CAM.
  • Disease progression to orbital and CNS involvement occurred in 23.9% and 12.8% of patients, respectively.
  • Overall mortality was 31%, with extensive disease linked to poorer outcomes and need for aggressive management.

Conclusions:

  • Uncontrolled diabetes and corticosteroid therapy are key risk factors for severe CAM.
  • Orbital and CNS involvement in CAM correlates with poor outcomes and necessitates aggressive surgical intervention.
  • Early diagnosis and prompt treatment are vital for improving survival rates in CAM patients.