S econdary infections are known to complicate the clinical course of coronavirus disease . Bacterial infections are the most common secondary infections, but increasing reports of systemic fungal infections are causing concern. In the early part of the COVID-19 pandemic, <1% of secondary infections reported in COVID-19 patients were fungal (1,2). Preexisting conditions, indiscriminate use of antimicrobial and glucocorticoid drugs, and lapses in infection control practices are putative factors contributing to the emergence of systemic fungal infections in severe COVID-19 cases (3). After incidence of candidemia and invasive aspergillosis in COVID-19 patients increased (4,5), awareness of possible fungal co-infections increased among clinicians and microbiologists. One study reported invasive fungal infections in ≈6% of hospitalized COVID-19 patients (6). Occasional reports of COVID-19-associated mucormycosis (CAM) from various centers (7,8) and a series of 18 cases from a city in South India increased our concerns about CAM (9). India has a high burden of mucormycosis among patients with uncontrolled diabetes mellitus, and many severe COVID-19 patients have diabetes (8,10). India also is one of the countries worst affected by the COVID-19 pandemic. Thus, we would expect India to have many CAM cases. We conducted a nationwide multicenter study to evaluate the epidemiology and outcomes of CAM and compare the results with cases of mucormycosis unrelated to COVID-19 (non-CAM). Methods Study Design and SettingWe conducted a retrospective observational study involving 16 healthcare centers across India (Figure 1).

Reinfections in COVID-19 are being reported all around the world and are a cause for concern, considering that a lot of our assumptions and modeling (including vaccination) related to the disease have relied on long-term immunity. We were one of the first groups to report a series of 4 healthcare workers to have been reinfected. This review article reports a scoping review of the available literature on reinfections, with a discussion of the implications of reinfections.

BackgroundThere are limited data regarding the incidence of pneumothorax in COVID-19 patients as well as the impact of the same on patient outcomes. MethodsA retrospective review of the medical records at three large tertiary care hospitals in Mumbai was performed to identify patients hospitalised with COVID-19 from March 2020 to October 2020. The presence of pneumothorax and/ or pneumomediastinum was noted when chest radiographs or CT scans were performed. Demographic and clinical characteristics of patients who developed air leak were recorded. Results 4,906 patients with COVID-19 were admitted, with 1,324 (27%) having severe COVID-19 disease. The overall incidence of pneumothorax and/or pneumomediastinum in patients with severe disease was 3.2% (42/1,324). Eighteen patients had pneumothorax, 16 had pneumomediastinum and 8 patients had both. Fourteen patients (33.3%) developed this complication breathing spontaneously, 28 patients (66.6%) developed it during mechanical ventilation. Overall mortality in this cohort was 74%, compared with 17% in the COVID-19 patients without pneumothorax (p<0.001).

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