Mycoses. 2022 Feb 25. doi: 10.1111/myc.13435. Online ahead of print.
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 1st April 2020 and 1st 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=0.017), presence of orbital symptoms (p=0.002), presence of diabetic ketoacidosis (p=0.011) and cerebral involvement (p=0.0004) 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.
PMID:35212032 | DOI:10.1111/myc.13435
