Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Mar;84(3):383-390.
doi: 10.1016/j.jinf.2021.12.039. Epub 2021 Dec 30.

Risk factors for Coronavirus disease-associated mucormycosis

Umang Arora  1 , Megha Priyadarshi  1 , Varidh Katiyar  2 , Manish Soneja  1 , Prerna Garg  1 , Ishan Gupta  1 , Vishwesh Bharadiya  1 , Parul Berry  1 , Tamoghna Ghosh  1 , Lajjaben Patel  1 , Radhika Sarda  1 , Shreya Garg  3 , Shubham Agarwal  1 , Veronica Arora  4 , Aishwarya Ramprasad  1 , Amit Kumar  1 , Rohit Kumar Garg  1 , Parul Kodan  1 , Neeraj Nischal  1 , Gagandeep Singh  5 , Pankaj Jorwal  1 , Arvind Kumar  1 , Upendra Baitha  1 , Ved Prakash Meena  1 , Animesh Ray  1 , Prayas Sethi  1 , Immaculata Xess  5 , Naval Vikram  1 , Sanjeev Sinha  1 , Ashutosh Biswas  1 , Alok Thakar  3 , Sushma Bhatnagar  6 , Anjan Trikha  7 , Naveet Wig  8
Affiliations

Risk factors for Coronavirus disease-associated mucormycosis

Umang Arora et al. J Infect. 2022 Mar.

Abstract

Background: The epidemiology of the Coronavirus-disease associated mucormycosis (CAM) syndemic is poorly elucidated. We aimed to identify risk factors that may explain the burden of cases and help develop preventive strategies.

Methods: We performed a case-control study comparing cases diagnosed with CAM and taking controls as recovered COVID 19 patients who did not develop mucormycosis. Information on comorbidities, glycemic control, and practices related to COVID-19 prevention and treatment was recorded. Multivariate regression analysis was used to identify independent predictors.

Results: A total of 352 patients (152 cases and 200 controls) diagnosed with COVID-19 during April-May 2021 were included. In the CAM group, symptoms of mucormycosis began a mean of 18.9 (SD 9.1) days after onset of COVID-19, and predominantly rhino-sinus and orbital involvement was present. All, but one, CAM cases had conventional risk factors of diabetes and steroid use. On multivariable regression, increased odds of CAM were associated with the presence of diabetes (adjusted OR 3.5, 95% CI 1.1-11), use of systemic steroids (aOR 7.7, 95% CI 2.4-24.7), prolonged use of cloth and surgical masks (vs. no mask, aOR 6.9, 95%CI 1.5-33.1), and repeated nasopharyngeal swab testing during the COVID-19 illness (aOR 1.6, 95% CI 1.2-2.2). Zinc therapy was found to be protective (aOR 0.05, 95%CI 0.01-0.19). Notably, the requirement of oxygen supplementation or hospitalization did not affect the risk of CAM.

Conclusion: Judicious use of steroids and stringent glycemic control are vital to preventing mucormycosis. Use of clean masks, preference for N95 masks if available, and minimizing swab testing after the diagnosis of COVID-19 may further reduce the incidence of CAM.

Keywords: COVID-19; Case control; Mucormycosis; Risk factors.

PubMed Disclaimer

Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Panel A: Date of symptom onset of COVID-19 illness for cases (green) and controls (blue), along with date of onset of mucormycosis symptoms for consecutive cases of CAM (red). The peak of symptom onset of COVID-19 for both groups was 20 April 2021 and of mucormycosis for cases was 15 May 2021. Panel B: Cumulative time to symptom onset of mucormycosis after the onset of COVID-19 symptoms in CAM. The first (Q1), second (Q2) and third quartile(Q3) represent 12, 18 and 26 days, respectively. CAM patients who were asymptomatic for COVID-19 are not included (n = 29). (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.)
Fig. 1
Fig. 1
Panel A: Date of symptom onset of COVID-19 illness for cases (green) and controls (blue), along with date of onset of mucormycosis symptoms for consecutive cases of CAM (red). The peak of symptom onset of COVID-19 for both groups was 20 April 2021 and of mucormycosis for cases was 15 May 2021. Panel B: Cumulative time to symptom onset of mucormycosis after the onset of COVID-19 symptoms in CAM. The first (Q1), second (Q2) and third quartile(Q3) represent 12, 18 and 26 days, respectively. CAM patients who were asymptomatic for COVID-19 are not included (n = 29). (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.)
Fig. 2
Fig. 2
Venn diagram depicting the distribution of cases with coronavirus disease-associated mucormycosis (CAM, blue) and controls (COVID-19 cases recovered without mucormycosis, yellow) in relation to the two main risk factors (diabetes mellitus, red; and systemic steroid therapy, green). Percentage out of the cases and controls are represented for each region in the parentheses. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
Fig. 3
Fig. 3
Risk of Coronavirus disease-associated mucormycosis depends on the type of mask and duration of usage. * represents significant difference compared to the use of N95 mask for <2 h.
See this image and copyright information in PMC

References

    1. Patel A., Agarwal R., Rudramurthy S.M., Shevkani M., Xess I., Sharma R., et al. Multicenter epidemiologic study of coronavirus disease–associated mucormycosis, India. Emerg Infect Dis. 2021;27 SepEarly Release. - PMC - PubMed
    1. Chakrabarti A., Dhaliwal M. Epidemiology of mucormycosis in India. Curr Fungal Infect Rep. 2013;7(4):287–292. Dec 1.
    1. Hindustan Times . Hindustan Times; 2021. Black fungus: here is a list of states with highest number of mucormycosis cases [Internet]https://www.hindustantimes.com/india-news/black-fungus-states-with-highe... [citedJun 21]. Available from.
    1. Cornely O.A., Alastruey-Izquierdo A., Arenz D., Chen S.C.A., Dannaoui E., Hochhegger B., et al. Global guideline for the diagnosis and management of mucormycosis: an initiative of the European Confederation of Medical Mycology in cooperation with the Mycoses Study Group Education and Research Consortium. Lancet Infect Dis. 2019;19(12):e405–e421. Dec. - PMC - PubMed
    1. WHO COVID-19 Case definition [Internet]. [cited 2021 Jun 21]. Available from: https://www.who.int/publications-detail-redirect/WHO-2019-nCoV-Surveilla...