Clinical Characteristics And Outcomes of 16 Cases With COVID19 and Mucormycosis: Experience From A Tertiary Care Center In India and Review of Literature

Abstract

Background-The sharp uptick in the cases of mucormycosis in the background of the COVID19 pandemic is a cause of concern and the reasons and it’s impact remains to be seen. We studied the clinical characteristics in patients with mucormycosis and COVID19 co-infection and performed a literature review.Methods-This retrospective study was conducted at tertiary centre in India. All patients admitted with COVID19 and mucormycosis were included, clinical details were obtained from hospital records. We did review of literatures using the terms “SARS-CoV2” OR “COVID19” AND “Mucormycosis” AND “co-infection” on Pubmed published before February 20, 2021.Results-Sixteen cases (M:F–13:3), mean age 46·5 years (24-75years), were included. Fourteen had known risk factors for mucormycosis, the most common being diabetes mellitus. Most patients (n=14) were symptomatic with mucormycosis before diagnosis of COVID19. There was delay in surgery by 22.5 days (IQR–>17.75–29.5), pending SARS-CoV-2 RT-PCR negativity. There were six deaths in this cohort, unrelated to the COVID19 severity. The literature review revealed eleven case reports on co-infection. Patients who had developed mucormycosis were found to have history of mechanical ventilation.Conclusion-The apparent increase in the incidence of mucormycosis may be due to decompensation of underlying comorbidities (decreased access to healthcare), and increased use of immunosuppressants in COVID19. Patients with co-infection were noted to have poorer outcomes.

Fungal sinusitis post COVID 19 – A case series from a diagnostic microbiology laboratory

“…This patient also had homolateral facial palsy which is a feature of acute rhinocerebral mucormycosis. 5 Multiple cranial nerve involvement in mucormycosis infection has been reported by Paul S et al 10 In our study, two patients having mucormycosis infections developed facial palsy.…”

A systematic review on SARS‐CoV‐2‐associated fungal coinfections

“…A multicentric retrospective study in India also showed a major risk factor in diabetes mellitus (75%) in COVID-19 and mucormycosis coinfection in comparison to chronic kidney disease (12.5%), chronic liver disease (6.25%), pulmonary tuberculosis (TB) (6.25%), and patients on immunosuppressive agents (6.25%). 70 Glucocorticoids are reported to cause immunosuppressive effects via transcriptional upregulation or repression of specific genes, especially nuclear factor κB (NF-κB). 71,72 It also affects T-lymphocyte interstitial pathology, which is itself a risk factor for invasive fungal infection in sinuses and lungs.…”

“Black fungus”: a perspective on the coronavirus disease 2019 (COVID‐19)‐associated rhino‐orbital mucormycosis epidemic in India

“…Multiple reports from India have documented a precipitate rise in coronavirus disease 2019 (COVID-19)associated rhino-orbito-cerebral mucormycosis (CAROM) since March 2020. 1,2 The overall risk of developing CAROM in the backdrop of COVID-19 was recently estimated to be approximately 1 in 400. 2 CAROM in India is typically being noted 2 to 4 weeks from the onset of COVID-19.…”

“…1,2 The overall risk of developing CAROM in the backdrop of COVID-19 was recently estimated to be approximately 1 in 400. 2 CAROM in India is typically being noted 2 to 4 weeks from the onset of COVID-19. The cause of the unexpectedly high incidence of CAROM in India has resulted in widespread speculation.…”

“…The unfortunate melding of these circumstances increases host susceptibility to CAROM and other opportunistic infections. [1][2][3] This triad in itself, however, may insufficiently explain the entire story of CAROM in India, and further scientific enquiry is ongoing. Unverified and speculative reports in the lay press have caused alarm by ascribing causation of CAROM to the use of industrial oxygen and unsterile water in oxygen humidifiers.…”