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. 2022 Nov 16;22(1):856.
doi: 10.1186/s12879-022-07844-y.

A case control investigation of COVID-19 associated mucormycosis in India

Tanu Anand  1 , Aparna Mukherjee  1 , Aanchal Satija  1 , Poonam Sharma Velamuri  1 , Kh Jitenkumar Singh  2 , Madhuchhanda Das  1 , Kripa Josten  1 , Pragya D Yadav  3 , Rima R Sahay  3 , Archana Y Keche  4 , Nitin M Nagarkar  4 , Prashant Gupta  5 , D Himanshu  5 , Sejal N Mistry  6 , Jimy D Patel  6 , Prajwal Rao  7 , Shalesh Rohatgi  7 , Soumitra Ghosh  8 , Avijit Hazra  8 , Anupma Jyoti Kindo  9 , Radha Annamalai  9 , Shivaprakash M Rudramurthy  10 , Mini P Singh  10 , Mohammad Shameem  11 , Nazish Fatima  11 , Janakkumar R Khambholja  12 , Sangita Parikh  13 , Manisha Madkaikar  14 , Vandana D Pradhan  14 , Sushila Kataria  15 , Pooja Sharma  15 , Samiran Panda  16 ; ICMR-Mucormycosis group
Collaborators, Affiliations

A case control investigation of COVID-19 associated mucormycosis in India

Tanu Anand et al. BMC Infect Dis. .

Abstract

Background: Increased occurrence of mucormycosis during the second wave of COVID-19 pandemic in early 2021 in India prompted us to undertake a multi-site case-control investigation. The objectives were to examine the monthly trend of COVID-19 Associated Mucormycosis (CAM) cases among in-patients and to identify factors associated with development of CAM.

Methods: Eleven study sites were involved across India; archived records since 1st January 2021 till 30th September 2021 were used for trend analysis. The cases and controls were enrolled during 15th June 2021 to 30th September 2021. Data were collected using a semi-structured questionnaire. Among 1211 enrolled participants, 336 were CAM cases and 875 were COVID-19 positive non-mucormycosis controls.

Results: CAM-case admissions reached their peak in May 2021 like a satellite epidemic after a month of in-patient admission peak recorded due to COVID-19. The odds of developing CAM increased with the history of working in a dusty environment (adjusted odds ratio; aOR 3.24, 95% CI 1.34, 7.82), diabetes mellitus (aOR: 31.83, 95% CI 13.96, 72.63), longer duration of hospital stay (aOR: 1.06, 95% CI 1.02, 1.11) and use of methylprednisolone (aOR: 2.71, 95% CI 1.37, 5.37) following adjustment for age, gender, occupation, education, type of houses used for living, requirement of ventilatory support and route of steroid administration. Higher proportion of CAM cases required supplemental oxygen compared to the controls; use of non-rebreather mask (NRBM) was associated as a protective factor against mucormycosis compared to face masks (aOR: 0.18, 95% CI 0.08, 0.41). Genomic sequencing of archived respiratory samples revealed similar occurrences of Delta and Delta derivates of SARS-CoV-2 infection in both cases and controls.

Conclusions: Appropriate management of hyperglycemia, judicious use of steroids and use of NRBM during oxygen supplementation among COVID-19 patients have the potential to reduce the risk of occurrence of mucormycosis. Avoiding exposure to dusty environment would add to such prevention efforts.

Keywords: Corticosteroids; Diabetes; Epidemic; Mucormycosis; Satellite.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Monthly trends for COVID associated mucormycosis (CAM) and COVID-19 cases
Fig. 2
Fig. 2
Study population enrollment flowchart
Fig. 3
Fig. 3
Maximum likelihood tree for the SARS-CoV-2 genomes retrieved in the study*. *Representative SARS-CoV-2 sequences from different lineages along with 81 sequences retrieved were used to generate the tree with a bootstrap replication of 1000 cycles. The retrieved pangolin lineages are marked on branches in different colors. The accession numbers of the retrieved sequences are highlighted in red. Fig Tree v1.4.4 and Inkscape were used to visualize and edit the generated tree
See this image and copyright information in PMC

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