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. 2022 Aug 8;17(8):e0272042.
doi: 10.1371/journal.pone.0272042. eCollection 2022.

Hyperglycemia and steroid use increase the risk of rhino-orbito-cerebral mucormycosis regardless of COVID-19 hospitalization: Case-control study, India

Manickam Ponnaiah  1 , Sivaraman Ganesan  2 , Tarun Bhatnagar  1 , Mahalakshmy Thulasingam  2 , Marie Gilbert Majella  1 , Mathan Karuppiah  1 , S A Rizwan  1 , Arun Alexander  2 , Sonali Sarkar  2 , Sitanshu Sekhar Kar  2 , Tamilarasu Kadhiravan  2 , Aparna Bhatnagar  3 , Prasanna Kumar S  4 , Vivekanandan M Pillai  2 , Pradeep Pankajakshan Nair  2 , Rahul Dhodapkar  2 , Pampa Ch Toi  2 , Rakesh Singh  2 , Nirupama Kasthuri  2 , Girish C P Kumar  1 , Saranya Jaisankar  1 , Vaibhav Saini  5 , Ankita Kankaria  5 , Anuradha Raj  5 , Amit Goyal  6 , Vidhu Sharma  6 , Satyendra Khichar  6 , Kapil Soni  6 , Mahendra Kumar Garg  6 , Kalaiselvi Selvaraj  7 , ShriKrishna B H  7 , Kranti Bhavana  8 , Bhartendu Bharti  8 , C M Singh  8 , Neha Chaudhary  8 , Vijayaravindh R  9 , Gopinath K  9 , Karthikeyan Palaninathan  9 , Simmi Dube  10 , Rita Singh Saxena  10 , Nikhil Gupta  10 , A Rathinavel  11 , S Priya  11 , Arulsundareshkumar  11 , Shama A Bellad  12 , Avinash Kavi  12 , Anilkumar S Harugop  12 , Kailesh Pujary  13 , Kirthinath Ballala  13 , Sneha Deepak Mallya  13 , Hanumanth M Prasad  14 , D Ravi  14 , N K Balaji  14 , Raghuraj Hegde  15 , Neha Mishra  15 , Shalina Ray  15 , S Karthikeyan  16 , Sudha Ramalingam  16 , A Murali  16 , Sudhakar Vaidya  17 , Mohit Samadhiya  17 , Dhaval Bhojani  17 , Somu Lakshmanan  4 , Sudagar R B Singh  4 , Nataraj Pillai  18 , P Deepthi  18 , K Banumathi  18 , V Sumathi  19 , D Ramesh  19 , Sonam Poonam Nissar  19 , Khushnood M Sheikh  20 , Manisha N Patel  20 , Vipul Shristava  20 , Suresh S Kumar  21 , K Shantaraman  21 , Rajkamal D Pandian  21 , Manoj Murhekar  1 , Rakesh Aggarwal  2
Affiliations

Hyperglycemia and steroid use increase the risk of rhino-orbito-cerebral mucormycosis regardless of COVID-19 hospitalization: Case-control study, India

Manickam Ponnaiah et al. PLoS One. .

Erratum in

  • Correction: Hyperglycemia and steroid use increase the risk of rhino-orbito-cerebral mucormycosis regardless of COVID-19 hospitalization: Case-control study, India.
    Ponnaiah M, Ganesan S, Bhatnagar T, Thulasingam M, Majella MG, Karuppiah M, Rizwan SA, Alexander A, Sarkar S, Kar SS, Kadhiravan T, Bhatnagar A, Kumar S P, Pillai VM, Nair PP, Dhodapkar R, Ch Toi P, Singh R, Kasthuri N, Kumar GCP, Jaisankar S, Saini V, Kankaria A, Raj A, Goyal A, Sharma V, Khichar S, Soni K, Garg MK, Selvaraj K, B H S, Bhavana K, Bharti B, Singh CM, Chaudhary N, R V, K G, Palaninathan K, Dube S, Singh Saxena R, Gupta N, Rathinavel A, Priya S, Arulsundareshkumar, Bellad SA, Kavi A, Harugop AS, Pujary K, Ballala K, Mallya SD, Prasad HM, Ravi D, Balaji NK, Hegde R, Mishra N, Ray S, Karthikeyan S, Ramalingam S, Murali A, Vaidya S, Samadhiya M, Bhojani D, Lakshmanan S, Singh SRB, Pillai N, Deepthi P, Banumathi K, Sumathi V, Ramesh D, Nissar SP, Sheikh KM, Patel MN, Shristava V, Kumar SS, Shantaraman K, Pandian RD, Murhekar M, Aggarwal R; I-MUCOR Study Group Investigators. Ponnaiah M, et al. PLoS One. 2025 Apr 4;20(4):e0322153. doi: 10.1371/journal.pone.0322153. eCollection 2025. PLoS One. 2025. PMID: 40184380 Free PMC article.

Abstract

Background: In the ongoing COVID-19 pandemic, an increased incidence of ROCM was noted in India among those infected with COVID. We determined risk factors for rhino-orbito-cerebral mucormycosis (ROCM) post Coronavirus disease 2019 (COVID-19) among those never and ever hospitalized for COVID-19 separately through a multicentric, hospital-based, unmatched case-control study across India.

Methods: We defined cases and controls as those with and without post-COVID ROCM, respectively. We compared their socio-demographics, co-morbidities, steroid use, glycaemic status, and practices. We calculated crude and adjusted odds ratio (AOR) with 95% confidence intervals (CI) through logistic regression. The covariates with a p-value for crude OR of less than 0·20 were considered for the regression model.

Results: Among hospitalised, we recruited 267 cases and 256 controls and 116 cases and 231 controls among never hospitalised. Risk factors (AOR; 95% CI) for post-COVID ROCM among the hospitalised were age 45-59 years (2·1; 1·4 to 3·1), having diabetes mellitus (4·9; 3·4 to 7·1), elevated plasma glucose (6·4; 2·4 to 17·2), steroid use (3·2; 2 to 5·2) and frequent nasal washing (4·8; 1·4 to 17). Among those never hospitalised, age ≥ 60 years (6·6; 3·3 to 13·3), having diabetes mellitus (6·7; 3·8 to 11·6), elevated plasma glucose (13·7; 2·2 to 84), steroid use (9·8; 5·8 to 16·6), and cloth facemask use (2·6; 1·5 to 4·5) were associated with increased risk of post-COVID ROCM.

Conclusions: Hyperglycemia, irrespective of having diabetes mellitus and steroid use, was associated with an increased risk of ROCM independent of COVID-19 hospitalisation. Rational steroid usage and glucose monitoring may reduce the risk of post-COVID.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Directed acyclic graph of Post COVID-19 rhino orbito cerebral mucormycosis for (a) ever-hospitalised and (b) never-hospitalised patients.
See this image and copyright information in PMC

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