Mucormycosis in COVID-19 Patients: A Case-Control Study

Abstract

(1) Background: During the second wave of COVID-19, India faced a rapid and sudden surge of not only COVID19-delta variant cases but also mucormycosis, making the infection even more fatal. We conducted a study to determine factors associated with the occurrence of mucormycosis in patients with COVID-19. (2) Methods: This case–control study comprised 121 patients; 61 cases (mucormycosis with COVID-19) and 60 controls. Patients were included from April 10, 2021 onwards. Follow-up was conducted after about 90 days and health status was recorded based on the modified Rankin Scale (mRS). (3) Results: Mucormycosis with COVID-19 cases had a median (IQR) age of 49 (43–59) years with 65.6% males and were older (95% CI 1.015–1.075; p = 0.002) than in the control group with median (IQR) 38 (29–55.5) years and 66.6% males. Baseline raised serum creatinine (OR = 4.963; 95% CI 1.456–16.911; p = 0.010) and D-dimer (OR = 1.000; 95% CI 1.000–1.001; p = 0.028) were independently associated with the occurrence of mucormycosis in COVID-19 patients. Additionally, diabetes mellitus (OR = 26.919; 95% CI 1.666–434.892; p = 0.020) was associated with poor outcomes and increased mortality in patients with mucormycosis with COVID-19 as per the multivariable analysis. A total of 30/61 mucormycosis patients had intracranial involvement. (4) Conclusions: The study observed elevated levels of baseline raised creatinine and D-dimer in mucormycosis pa-tients with COVID-19 as compared to the control group. However, future studies may be conducted to establish this cause–effect relationship.

Changing Trend of Risk Factors of Mucormycosis Including Diabetes, Acidosis, and Serum Iron in the Second Wave of COVID-19

“…Due to this unprecedented spike, mucormycosis could be called a public health concern as of now. In the present study a higher incidence in men (64.71%) than women (35.29%) has been found similar to the other post covid studies [ 7 ]. The youngest patient was 30 years old and the eldest was 86 years.…”

“…The absence of pediatric mucor cases could have been because COVID-19 did not affect children as severely as adults [ 12 ]. Mean or average age of our study (53.96 years) was similar in that of other post covid studies (49 years, 51.7 years and 55 years) [ 4 , 5 , 7 ].…”

“…1 c). The percentage of diabetic patients ranged from 31.7 to 85.71% of the post COVID 19 mucormycosis ones in other works [ 4 , 5 , 7 ].…”

“…Another work has found elevated serum iron in people with COVID-19 and ketoacidosis [ 15 ]. Serum ferritin values have been found elevated in two studies [ 5 , 7 ], and yet another mentions variable result [ 4 ]. However, 37.25% of the participants had serum iron values below normal range (Fig.…”

“…There is role of presence of diabetic acidosis and external iron in increasing this availability [ 1 ]. The few available post COVID studies have found the serum iron or serum transferrin values to be variable [ 4 , 5 , 7 ]. Thus, there is a need of the risk factors to be studied to suggest or refute the role of newer or neglected ones.…”