COVID-19 associated mucormycosis in Assiut University Hospitals: a multidisciplinary dilemma

Abstract

Mucormycosis is a life-threatening opportunistic angioinvasive fungal infection. We aimed to describe the frequency, presentations, predictors, and in-hospital outcome of mucormycosis patients in the scope of CoronaVirusDisease-19 (COVID-19) during the third viral pandemic wave. This cross-sectional retrospective study included all patients who fulfilled the criteria of mucormycosis with concurrent confirmed covid19 infection admitted to Assuit University Hospital between March 2021 and July 2021. Overall, 433 patients with definite covid-19 infection, of which 33 (7.63%) participants were infected with mucormycosis. Mucormycosis was predominantly seen in males (21 vs. 12; p = 0.01). Diabetes mellitus (35% vs. 63.6%; p < 0.001), hypertension (2% vs.45.5%; p 0.04), and Smoking (26.5% vs. 54.5%; p < 0.001) were all significantly higher in mucormycosis patients. Inflammatory markers, especially E.S.R., were significantly higher in those with mucormycosis (p < 0.001). The dose of steroid intake was significantly higher among patients with mucormycosis (160 mg vs. 40 mg; p < 0.001). Except for only three patients alive by residual infection, 30 patients died. The majority (62%) of patients without mucormycosis were alive. Male sex; Steroid misuse; D.M.; Sustained inflammation; Severe infection were significant risk factors for mucormycosis by univariate analysis; however, D.M.; smoking and raised E.S.R. were predictors for attaining mucormycosis by multivariate analysis.

Fungal infection profile in critically ill COVID-19 patients: a prospective study at a large teaching hospital in a middle-income country

“…Poorly controlled diabetes and diabetic ketoacidosis have been linked to an increased risk of mucormycosis in COVID-19 patients [ 48 ].Free,unbound iron in the serum also contributes to mucormycosis development in addition to uncontrolled hyperglycemia. Higher levels of serum-free iron have been linked to acidosis and proton-mediated displacement of ferric iron from transfer in diabetic ketoacidosis, both of which are major risk factors for mucormycosis [ 49 ].Also, Moorthy et al [ 50 ] concluded that there is a significant increase in the incidence of maxillofacial fungal infections in patients with diabetes treated for SARS-CoV-2, with a strong association with corticosteroid administration. Neutropenia, malignancy, organ transplant, immunosuppression, and chemotherapy are all risk factors for opportunistic fungal infection [ 43 ].…”

“…Another indirect connection between the concomitant rise in COVID-19 and mucormycosis is the proliferation of fungal spores in the water used in oxygen humidifiers. In hospital water, fungi such as Mucorales can grow and reproduce [ 49 ].…”

Mucormycosis, New Causative Agents, and New Susceptible Populations: Review of Cases in a Tertiary Care Hospital in Iran (2007-2021)

“…Steroid dosage was significantly higher among patients with mucormycosis. In this center, 90% of patients died due to mucormycosis ( 18 ).…”

Post-COVID-19 Fungal Infection in the Aged Population

“…COVID-19 infection fosters an environment that is favorable to mucormycosis and becomes more prevalent in patients who are battling or recovering from COVID-19 [ 40 ]. Humans can contract two different types of mucormycosis infection.…”