Coronavirus Disease-Associated Mucormycosis from a Tertiary Care Hospital in India: A Case Series

Abstract

Background: Coronavirus disease (COVID-19) remains a health concern with new challenges emerging as the pandemic progresses. The recent rise of opportunistic infections especially mucormycosis in COVID-19 patients is further complicating their outcomes. Mucormycosis is well known to infect patients with diabetes mellitus, malignancy, chemotherapy, and other immunocompromised conditions. The treatment of COVID-19 largely remains systemic steroids and other immunomodulators that add to the risk of invasive fungal infection.Methodology: Here, we present a retrospective case series of 13 patients with individual clinical characteristics along with the demography and treatment details. The data were collected retrospectively in a single center that caters to a large population of COVID-19 patients with varying severity.Results: Thirteen patients were presented with COVID-19 associated mucormycosis (CAM). The median age was higher in non-survivors (49.5 years), with a higher odds of death (23.8) in those with severe COVID, having overall mortality of 64.3%. Moreover, diabetes mellitus was present in 61.5% of patients with a mortality of 75%. About 11 (84.6%) patients had received prior steroids for COVID-19. The incidence of hyperglycemia at admission was equal among both survivors and non-survivors. Conclusion:The prevalence of mucormycosis seems to be increasing among COVID-19 patients which may be associated with increased use of steroids, the possible immunocompromised state imposed by SARS-CoV-2, or co-existing conditions such as diabetes mellitus. The mortality of CAM is remarkably high and apart from preventive practices and rational use of immunomodulators, a high index of suspicion with early diagnosis would be key to survival.

Postoperative clinical nursing care pathway for patients with mucormycosis: An experience from a tertiary care hospital in Rajasthan, India

“…Our findings indicated that a significant number of patients (72.2%) had received steroids for COVID-19. These findings were similar to previous studies, which reported that (84.6%) patients had received prior steroids for COVID-19[ 11 ]. Furthermore, our study revealed that 37% of the patient received oxygen therapy during hospitalization as a part of treatment for COVID-19 infection, which is very significant with the finding of another study where 57% of patient needed oxygen support for COVID-19 infection [ 12 ].…”

Clinical Features and Mortality of COVID-19-Associated Mucormycosis: A Systematic Review and Meta-Analysis

“…[ 58 ] India Case series Single-center 5 – [33–70] 20 (1) 100 (5) Singh Y. [ 59 ] India Case series Single-center 13 Nov 2020–Jan 2021 [5–75] 85 (11) 62 (8) Garg R. [ 60 ] India Case series Single-center 7 May 2021 [38–70] 71 (5) 100 (7) Arana C. [ 61 ] Spain Case series Single-center 2 – [48–62] 100 (2) 50 (1) Barman Roy D. [ 62 ] India Case series Single-center 2 – [39–50] 50 (1) 50 (1) Ashour MM. [ 63 ] Egypt Case series Single-center 6 – [41–67] 50 (3) 100 (6) Pal P. [ 64 ] India Case series Single-center 10 ...…”

“…[ 58 ] 40 (2) – – – – 20 (1) 40 (2) – Singh Y. [ 59 ] 46 (6) – 15 (2) 23 (3) 85 (11) 69 (9) 77 (10) 77 (10) Garg R. [ 60 ] – – – 29 (2) 0 (0) 100 (7) 0 (0) Arana C. [ 61 ] 100 (2) 100 (2) 100 (2) 100 (2) 0 (0) 100 (2) 50 (1) Barman Roy D. [ 62 ] – – – 0 (0) 0(0) 50 (1) – Ashour MM. [ 63 ] – 17 (1) – – – – – Pal P. [ 64 ] – 10 (1) – 30 (3) – 80 (8) – …”

Black fungus outbreak in India – A direct consequence of COVID-19 surge: A myth or reality

“… Akinosoglou et al, 2021 , Banerjee et al, 2021 , Biswas, 2021 , CSSE, 2021 , CDC, 2021 , CDC, 2020 , Chaudhry et al, 1987 , Kontoyiannis et al, 2010 , Medicover Hospitals, 2021 , NIH, 2021 , Neblett Fanfair et al, 2012 , Ong et al, 2021 , Pappas et al, 2010 , Park et al, 2011 , Rees et al, 1998 , Singh et al, 2021a , Singh et al, 2021b .…”