Results from a national survey on COVID‐19‐associated mucormycosis in Germany: 13 patients from six tertiary hospitals

Abstract

Background Most COVID‐19‐associated mucormycosis (CAM) cases are reported from India and neighbouring countries. Anecdotally cases from Europe have been presented. Objective To estimate the disease burden and describe the clinical presentation of CAM in Germany. Methods We identified cases through German mycology networks and scientific societies, and collected anonymised clinical information via FungiScope®. Results We identified 13 CAM cases from six tertiary referral hospitals diagnosed between March 2020 and June 2021. Twelve patients had severe or critical COVID‐19, eleven were mechanically ventilated for a median of 8 days (range 1‐27 days) before diagnosis of CAM. Eleven patients received systemic corticosteroids. Additional underlying medical conditions were reported for all but one patient, five were immunocompromised because of malignancy or organ transplantation, three were diabetic. Eleven patients developed pneumonia. Mortality was 53.8% with a median time from diagnosis of mucormycosis to death of 9 days (range 0–214 days) despite treatment with liposomal amphotericin B and/or isavuconazole in 10 of 13 cases. CAM prevalence amongst hospitalised COVID‐19 patients overall (0.67% and 0.58% in two centres) and those admitted to the intensive care unit (ICU) (1.47%, 1.78% and 0.15% in three centres) was significantly higher compared to non‐COVID‐19 patients (P < .001 for respective comparisons). Conclusion COVID‐19‐associated mucormycosis is rare in Germany, mostly reported in patients with comorbidities and impaired immune system and severe COVID‐19 treated in the ICU with high mortality compared to mainly rhino‐orbito‐cerebral CAM in patients with mild COVID‐19 in India. Risk for CAM is higher in hospitalised COVID‐19 patients than in other patients.

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

“…Of the remaining 53 studies, we excluded 2 case series [ 18 , 19 ] because observational studies with larger sample sizes have been published by the same authors. Eventually, 36 observational studies and 15 case series with a total of 2,312 proven CAM cases were included in our meta-analysis [ 7 , 9 , 20 – 68 ](Fig. 1 ).…”

“…[ 66 ] Egypt Case series Single-center 14 – [29–77] 71 (10) 100 (14) Alloush TK. [ 67 ] Egypt Case series Single-center 14 May 2021–Jun 2021 [49–82] 64 (9) 93 (!3) Seidel D. [ 68 ] Germany Case series Multi-center 13 Feb 2020–Jun 2021 [30–75] 62 (8) 23 (3) Author HTN, % (N) CKD, % (N) Immunosuppression, % (N) Malignancy, % (N) Hypoxia, % (N) Mechanical ventilation, % (N) Corticosteroids treatment, % (N) ICU admission, % (N) Moorthy A. [ 20 ] – – – – – – 88 (15) – El-Kholy NA.…”

“…[ 66 ] – – – – – – 21 (3) Alloush TK. [ 67 ] 43 (6) 14 (2) – 100 (14) 0 (0) 93 (13) – Seidel D. [ 68 ] – 7.7 (1) 38 (5) – 79 (11) 79 (11) 79 (11) Value is shown as mean ± SD or median [range]. The columns of hypoxia, mechanical ventilation, corticosteroids treatment, and ICU admission was the data regarding COVID-19 severity and management.…”

Prevalence of COVID-19 Associated Mucormycosis in a German Tertiary Care Hospital

“…In India, localized forms of mucormycosis predominate not only in non-COVID-19 patients with hematological diseases (72% [ 14 ]) second to lung involvement (58%) but also in patients with COVID-19 (up to 90% with rhino-orbito-cerebral mucormycosis and <10% pulmonary disease [ 6 , 7 ]). In Germany, pulmonary mucormycosis were more frequent than rhino-orbito-cerebral mucormycosis [ 15 ]. Seidel et al investigated the prevalence of CAM in Germany.…”

“…Seidel et al investigated the prevalence of CAM in Germany. They found 13 cases from six tertiary hospitals in Germany between January 2020 and June 2021, and they depicted a higher prevalence of CAM in only two centers (2 out of 100,000 and 8 out of 100,000) [ 15 ]. Up to now, systematic studies for the prevalence of CAM from Europe are missing.…”