Epidemiology, clinical presentation and management of COVID‐19 associated mucormycosis: A single centre experience from Pune, Western India
Ameet Dravid, Reema Kashiva, Zafer Khan, Balasaheb D Bande, Danish Memon, Aparna Kodre, Milind Mane, Vishal Pawar, Dattatraya Patil, S Kalyani, Prathamesh Raut, Madhura Bapte, Charlotte Saldanha, Dinesh Chandak, Teerthagouda Patil, S.L.C. Reddy, Krushnadas Bhayani, Laxmi Suresh, Vishnu Dillibabu, Shipra Srivastava, Shubham Khandelwal, Sailee More, Atif Shakeel, Mohit Pawar, Pranava Nande, Amol Harshe, Sagar Kadam, Sudhir Hallikar, Nudrat Kamal, Danish Zamir Andrabi, Sachin Bodhale, Akshay Raut, Sangeeta Chandrashekhar, Chandrashekhar Raman, Uma Mahajan, Gaurav N. Joshi, Dilip Mane
Abstract
BACKGROUND: The second COVID-19 wave in India has been associated with an unprecedented increase in cases of COVID-19 associated mucormycosis (CAM), mainly Rhino-orbito-cerebral mucormycosis (ROCM). METHODS: This retrospective cohort study was conducted at Noble hospital and Research Centre (NHRC), Pune, India, between 1 April, 2020, and 1 August, 2021, to identify CAM patients and assess their management outcomes. The primary endpoint was incidence of all-cause mortality due to CAM. RESULTS: 59 patients were diagnosed with CAM. Median duration from the first positive COVID-19 RT PCR test to diagnosis of CAM was 17 (IQR: 12,22) days. 90% patients were diabetic with 89% having uncontrolled sugar level (HbA1c >7%). All patients were prescribed steroids during treatment for COVID-19. 56% patients were prescribed steroids for non-hypoxemic, mild COVID-19 (irrational steroid therapy), while in 9%, steroids were prescribed in inappropriately high dose. Patients were treated with a combination of surgical debridement (94%), intravenous liposomal Amphotericin B (91%) and concomitant oral Posaconazole (95.4%). 74.6% patients were discharged after clinical and radiologic recovery while 25.4% died. On relative risk analysis, COVID-19 CT severity index ≥18 (p = .017), presence of orbital symptoms (p = .002), presence of diabetic ketoacidosis (p = .011) and cerebral involvement (p = .0004) were associated with increased risk of death. CONCLUSIONS: CAM is a rapidly progressive, angio-invasive, opportunistic fungal infection, which is fatal if left untreated. Combination of surgical debridement and antifungal therapy leads to clinical and radiologic improvement in majority of cases.