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Multicenter Study
. 2023 Apr;51(2):407-416.
doi: 10.1007/s15010-022-01891-y. Epub 2022 Aug 3.

COVID-19 associated multisystemic mucormycosis from India: a multicentric retrospective study on clinical profile, predisposing factors, cumulative mortality and factors affecting outcome

Monalisa Sahu  1 , Milap Shah  2 , Venkateswara R Mallela  3 , Venkat Raman Kola  4 , Hari Kishan Boorugu  3 , Arshad A R Punjani  3 , R Vijay Kumar  5 , Sairaj Kumar  5 , Manusrut Manusrut  5 , S Ch Raghu Kumar  5 , Rajkumar Rathod  6 , Dilip M Babu  7 , Hari Kishan Gonuguntla  8 , Gopi Krishna Yedlapati  8 , Gangadhar Reddy Mallu  8 , Y Sai Reddy  8 , Vedire Vishnu Reddy  9 , Surendar Alwala  10 , Vijay Kumar Bongu  3 , A Kamalesh  3 , R N Komal Kumar  11 , Ganesh S Jaishetwar  12 , Ravi Shankar Bagapally  13 , Jammula S Srinivas  14 , Anandh Balasubramaniam  15 , Balasubramoniam Kavumkal Rajagopalan  16 , Bhulaxmi Pullikanti  2 , Swathi P Prakasham  17 , Pavani Nimmala  17 , Barla Nagaraju  8 , Pradipt R Sahoo  5 ; MuCOVIDYH group
Collaborators, Affiliations
Multicenter Study

COVID-19 associated multisystemic mucormycosis from India: a multicentric retrospective study on clinical profile, predisposing factors, cumulative mortality and factors affecting outcome

Monalisa Sahu et al. Infection. 2023 Apr.

Abstract

Purpose: The clinical course of COVID-19 has been complicated by secondary infections, including bacterial and fungal infections. The rapid rise in the incidence of invasive mucormycosis in these patients is very much concerning. COVID-19-associated mucormycosis was detected in huge numbers during the second wave of the COVID-19 pandemic in India, with several predisposing factors indicated in its pathogenesis. This study aimed to evaluate the epidemiology, predisposing factor, cumulative mortality and factors affecting outcomes among the coronavirus disease COVID-19-associated mucormycosis (CAM).

Methods: A multicenter retrospective study across three tertiary health care centers in Southern part of India was conducted during April-June 2021.

Results: Among the 217 cases of CAM, mucormycosis affecting the nasal sinuses was the commonest, affecting 95 (44%) of the patients, orbital extension seen in 84 (38%), pulmonary (n = 25, 12%), gastrointestinal (n = 6, 3%), isolated cerebral (n = 2) and disseminated mucormycosis (n = 2). Diabetes mellitus, high-dose systemic steroids were the most common underlying disease among CAM patients. The mucormycosis-associated case-fatality at 6 weeks was 14%, cerebral or GI or disseminated mucormycosis had 9 times higher risk of death compared to other locations. Extensive surgical debridement along with sequential antifungal drug treatment improved the survival in mucormycosis patients.

Conclusion: Judicious and appropriate management of the predisposing factor and factors affecting mortality associated with CAM with multi-disciplinary approach and timely surgical and medical management can be much helpful in achieving a successful outcome.

Keywords: COVID-19; COVID-19 Associated Mucormycosis (CAM); Cerebral mucormycosis; Gastro-intestinal mucormycosis; Mucormycosis; Pulmonary mucormycosis; Sino-nasal mucormycosis.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Intra-operative findings of patients with Mucormycosis. a Black ulcerative lesion at ileocaecal junction. b Left maxilla and buccal mucosa showing large ulcer with necrosis and teeth loosening. c The image shows pieces of infrastructure maxillectomy showing necrosis with loosened teeth
Fig. 2
Fig. 2
Histopathological features of biopsy from mucormycosis patients. a Histopathology images showing broad, aseptate, thick-walled fungal hyphae in necrotic tissue. b GMS stain highlighting fungal hyphae in black colour
Fig. 3
Fig. 3
Kaplan Meier survival estimates of cumulative probability of survival at various time points during the first 40 days are the onset of COVID-19 associated mucormycosis
Fig. 4
Fig. 4
Kaplan Meier survival estimates showing a comparison of cumulative probability of survival based on anatomic location of mucormycosis
See this image and copyright information in PMC

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