Epidemiology, clinical presentation and management of COVID‐19 associated mucormycosis: A single centre experience from Pune, Western India. Issue 5 (10th March 2022)

• Record Type: Journal Article
• Authors: Dravid, Ameet; Kashiva, Reema; Khan, Zafer; Bande, Balasaheb; Memon, Danish; Kodre, Aparna; Mane, Milind; Pawar, Vishal; Patil, Dattatraya; Kalyani, Suraj; Raut, Prathamesh; Bapte, Madhura; Saldanha, Charlotte; Chandak, Dinesh; Patil, Teerthagouda; Reddy, Sateesh; Bhayani, Krushnadas; Suresh, Laxmi; Dillibabu, Vishnu; Srivastava, Shipra; Khandelwal, Shubham; More, Sailee; Shakeel, Atif; Pawar, Mohit; Nande, Pranava; Harshe, Amol; Kadam, Sagar; Hallikar, Sudhir; Kamal, Nudrat; Andrabi, Danish; Bodhale, Sachin; Raut, Akshay; Chandrashekhar, Sangeeta; Raman, Chandrashekhar; Mahajan, Uma; Joshi, Gaurav; Mane, Dilip;
• Is Part Of: Mycoses. Volume 65:Issue 5(2022)
• Page Start: 526
• Page End: 540
• Publication Date: 2022-03-10
• Subjects: Amphotericin B -- COVID‐19 associated Mucormycosis -- diabetes mellitus -- Posaconazole -- Rhino‐orbito‐cerebral mucormycosis -- steroids; Pathogenic fungi -- Periodicals; Medical mycology -- Periodicals; 616.969
• DOI: 10.1111/myc.13435
• Languages: English
• ISSNs: 0933-7407

Abstract

Abstract: Background: The second COVID‐19 wave in India has been associated with an unprecedented increase in cases of COVID‐19 associated mucormycosis (CAM), mainly Rhino‐orbito‐cerebral mucormycosis (ROCM). Methods: This retrospective cohort study was conducted at Noble hospital and Research Centre (NHRC), Pune, India, between 1 April, 2020, and 1 August, 2021, to identify CAM patients and assess their management outcomes. The primary endpoint was incidence of all‐cause mortality due to CAM. Results: 59 patients were diagnosed with CAM. Median duration from the first positive COVID‐19 RT PCR test to diagnosis of CAM was 17 (IQR: 12, 22) days. 90% patients were diabetic with 89% having uncontrolled sugar level (HbA1c >7%). All patients were prescribed steroids during treatment for COVID‐19. 56% patients were prescribed steroids for non‐hypoxemic, mild COVID‐19 (irrational steroid therapy), while in 9%, steroids were prescribed in inappropriately high dose. Patients were treated with a combination of surgical debridement (94%), intravenous liposomal Amphotericin B (91%) and concomitant oral Posaconazole (95.4%). 74.6% patients were discharged after clinical and radiologic recovery while 25.4% died. On relative risk analysis, COVID‐19 CT severity index ≥18 ( p = .017), presence of orbital symptoms ( p = .002), presence of diabetic ketoacidosis ( p = .011) and cerebral involvement ( p = .0004) were associated with increased risk of death. Conclusions: CAM is a rapidly progressive, angio‐invasive, opportunistic fungal infection, which is fatal if left untreated. Combination of surgical debridement and antifungal therapy leads to clinical and radiologic improvement in majority of cases.