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. 2022 May;65(5):526-540.
doi: 10.1111/myc.13435. Epub 2022 Mar 10.

Epidemiology, clinical presentation and management of COVID-19 associated mucormycosis: A single centre experience from Pune, Western India

Ameet Dravid  1 , Reema Kashiva  2 , Zafer Khan  3 , Balasaheb Bande  3 , Danish Memon  2 , Aparna Kodre  2 , Milind Mane  3 , Vishal Pawar  3 , Dattatraya Patil  3 , Suraj Kalyani  3 , Prathamesh Raut  3 , Madhura Bapte  3 , Charlotte Saldanha  3 , Dinesh Chandak  3 , Teerthagouda Patil  3 , Sateesh Reddy  2 , Krushnadas Bhayani  2 , Laxmi Suresh  2 , Vishnu Dillibabu  2 , Shipra Srivastava  2 , Shubham Khandelwal  2 , Sailee More  2 , Atif Shakeel  2 , Mohit Pawar  2 , Pranava Nande  2 , Amol Harshe  4 , Sagar Kadam  5 , Sudhir Hallikar  6 , Nudrat Kamal  6 , Danish Andrabi  6 , Sachin Bodhale  7 , Akshay Raut  8 , Sangeeta Chandrashekhar  9 , Chandrashekhar Raman  10 , Uma Mahajan  11 , Gaurav Joshi  12 , Dilip Mane  2
Affiliations

Epidemiology, clinical presentation and management of COVID-19 associated mucormycosis: A single centre experience from Pune, Western India

Ameet Dravid et al. Mycoses. 2022 May.

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.

Keywords: Amphotericin B; COVID-19 associated Mucormycosis; Posaconazole; Rhino-orbito-cerebral mucormycosis; diabetes mellitus; steroids.

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Figures

FIGURE 1
FIGURE 1
Prevalence of risk factors in CAM patients who died
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