Insights from Surgically treated Post Covid Acute Invasive Fungal Rhino-Orbital sinusitis in Chandrapur Study (SPAROS): A Population Based study of Coronavirus Associated Mucormycosis (CAM) characteristics in India

Epidemiology of COVID-19–Associated Mucormycosis

“…Diabetes seems to be associated with 66% of cases reported from India vs. 55% of cases from elsewhere [ 31 ]. Prevalence of diabetes seems to be anywhere from 55% to up to 100% in reported case series with CAM [ 25 – 27 , 29 , 32 – 34 ] and several case series reported new onset diabetes in subjects with no prior history of diabetes [ 25 – 28 , 35 , 36 ].…”

“… Singh A Singh C, Joshi S et al [ 98 ] Scientific literature search and systematic review of published data till 5/2021 101 cases 82 cases from India 22-86 79% male Sinus 89%CNS involvement 22%, pulmonary 7.9% 80%, new onset diabetes 2.2% NA 76% Not reported 30.7% trinity of diabetes, rampant use of corticosteroid in a background of COVID-19 appears to increase mucormycosis. Kasatwar A, Shukla R, Rathod N et al [ 36 ] Observational study single district in, India of surgically treated patients with ROCM 3/2021-12/2021 100 cases 49.3 years 70% male Sinus or Rhinoorbital involvement only 95%, 52% with new onset diabetes NA 76% 95% 2% Incidence of 7.1/1000 patients noted in hospitalized patients with COVID-19 with steroid use and diabetes being the main risk factors, with increased GRP78 expression being postulated as underlying mechanism for infection Tavakolpour S, Irani S, Yekaninejad M et al [ 35 ] Retrospective observational case control study of single center in Iran 2/2020-9/2021 52 CAM 130 controls 57 years 63% male 100% ROCM Rhinoorbital 11.5%, sinus 34.6% and cerebral involvement 54% 55.8, new hyperglycemia 46% Severe COVID or need for O2 46% 88.5% Not reported 21.1 % mortality in CAM group CAM had higher odds of severe COVID (OR 3.6), prior diabetes (OR 7.37), smoking (OR 4.55), or receipt of high dose /pulse steroid therapy Dave T, Gopinathan Nair A, Hegde R et al [ 33 ] Retrospective multicentric observational case series of ROCM, India, 5/2021 58 56 years 76% male 100% ROCM 33% CNS extension 88% All patients had covid 19 infection, severity not reported 83% 100% 34% at mean 5.6 months follow up Uncontrolled DM, orbital apex involvement, CNS involvement and steroid use associated with unfavorable outcome. CNS involvement associated with risk of mortality Rao K, Pooja N [ 99 ] Observational study from ENT clinic, single center, India 180 40-60 years ...…”

“…They seemed to have lower levels of hyperglycemia and less severe CAM disease with good prognosis. In contrast, the other group was of people with long standing diabetes with severe COVID who presented with more extensive disease needing more extensive surgery and with poorer outcomes [ 36 ]. They also described a series of patients with no steroid use or diabetes with a predilection of jaw involvement.…”