Risk factors for Coronavirus disease-associated mucormycosis

Abstract

Background The epidemiology of the Coronavirus-disease associated mucormycosis (CAM) syndemic is poorly elucidated. We aimed to identify risk factors that may explain the burden of cases and help develop preventive strategies. Methods We performed a case-control study comparing cases diagnosed with CAM and taking controls as recovered COVID 19 patients who did not develop mucormycosis. Information on comorbidities, glycemic control, and practices related to COVID-19 prevention and treatment was recorded. Multivariate regression analysis was used to identify the independent predictors. Results A total of 352 patients (152 cases and 200 controls) diagnosed with COVID-19 during April-May 2021 were included. In the CAM group, symptoms of mucormycosis began a mean of 18.9 (SD 9.1) days after onset of COVID-19, and predominantly rhino-sinus and orbital involvement was present. All, but one, CAM cases had conventional risk factors of diabetes and steroid use. On multivariable regression, increased odds of CAM were associated with the presence of diabetes (adjusted OR 3.5, 95%CI 1.1-11), use of systemic steroids (aOR 7.7,95% CI 2.4-24.7), prolonged use of cloth and surgical masks (vs. no mask, aOR 6.9, 95%CI 1.5-33.1), and repeated nasopharyngeal swab testing during the COVID-19 illness (aOR 1.6,95% CI 1.2-2.2). Zinc therapy was found to be protective (aOR 0.05, 95%CI 0.01-0.19). Notably, the requirement of oxygen supplementation or hospitalization did not affect the risk of CAM. Conclusion Judicious use of steroids and stringent glycemic control are vital to preventing mucormycosis. Use of clean masks, preference for N95 masks if available, and minimizing swab testing after the diagnosis of COVID-19 may further reduce the incidence of CAM.

A case control investigation of COVID-19 associated Mucormycosis in India

“…The socio-demographic pro le of CAM cases in our study were similar to that in other Indian studies from Chandigarh, Delhi and Pune, and an online Mycotic Infections in COVID-19 (MUNCO) registry [6, [17][18][19][20]. Saprophytic fungi such as mucorales are found in ecological spaces such as soil, dust and decomposing vegetation [21].…”

“…Evidence is equivocal with respect to the role of supplemental oxygen during COVID-19 illness and subsequent development of CAM. While the current study and other studies on CAM showed higher requirement of oxygen among CAM cases during COVID illness [6,27], studies conducted in other Indian cities such as Delhi and Pune did not witness such association [17,19]. Interestingly, use of NRBM was found to be protective factor against in the current investigation.…”

Rhino-Orbital Mucormycosis After COVID-19 Infection in a Patient With Non-Hodgkin’s Lymphoma

“…Our patient was diagnosed with NHL and during her COVID-19 illness, she received high dose glucocorticoids too, altogether facilitating the development of aggressive fungal infection. A number of recent but sporadic invasive fungal infections have been reported in recovered COVID-19 patients, including COVID-19 associated pulmonary aspergillosis (CAPA) and COVID-19 associated mucormycosis (CAM) [ 12 ]. Mucormycosis in a non-immunocompromised patient has been reported in Bangladesh during the pre-COVID era [ 6 ].…”

Mucormycosis in the COVID-19 Environment: A Multifaceted Complication

“…Zinc chelators along with amphotericin B and posaconazole were effective against 6 Mucor species ( Leonardelli et al., 2019 ). A study found zinc supplementation to be protective in CAM ( Arora et al., 2022 ). Nonetheless, more studies are required to conclude whether zinc supplementation confers protection or makes individuals susceptible to mucormycosis.…”