Multicenter Case–Control Study of COVID-19–Associated Mucormycosis Outbreak, India
Valliappan Muthu, Ritesh Agarwal, Shivaprakash M. Rudramurthy, Deepak Thangaraju, Manoj Shevkani, Atul Patel, Prakash Shastri, Ashwini Tayade, Sudhir Bhandari, Vishwanath Gella, Jayanthi Savio, Surabhi Madan, Vinaykumar Hallur, Venkata Nagarjuna Maturu, Arjun Srinivasan, Nandini Sethuraman, Raminder Pal Singh Sibia, Sanjay Pujari, Ravindra Mehta, Tanu Singhal, Puneet Saxena, Varsha Gupta, Vasant Nagvekar, Parikshit Prayag, Dharmesh Patel, Immaculata Xess, Pratik Savaj, Naresh K. Panda, Gayathri Devi Rajagopal, Riya Sandeep Parwani, Kamlesh Patel, Anuradha Deshmukh, Aruna Vyas, Srinivas Kishore Sistla, Priyadarshini A. Padaki, Dharshni Ramar, Saurav Sarkar, Bharani Rachagulla, Pattabhiraman Vallandaramam, Krishna Prabha Premachandran, Sunil Pawar, Piyush Gugale, Pradeep Hosamani, Sunil Narayan Dutt, Satish Chandrasekhar Nair, Hariprasad Kalpakkam, Sanjiv Badhwar, Kiran Kumar Kompella, Nidhi Singla, Milind Navlakhe, Amrita Prayag, Gagandeep Singh, Poorvesh Dhakecha, Arunaloke Chakrabarti
Abstract
We performed a case–control study across 25 hospitals in India for the period of January–June 2021 to evaluate the reasons for an COVID-19–associated mucormycosis (CAM) outbreak. We investigated whether COVID-19 treatment practices (glucocorticoids, zinc, tocilizumab, and others) were associated with CAM. We included 1,733 cases of CAM and 3,911 age-matched COVID-19 controls. We found cumulative glucocorticoid dose (odds ratio [OR] 1.006, 95% CI 1.004–1.007) and zinc supplementation (OR 2.76, 95% CI 2.24–3.40), along with elevated C-reactive protein (OR 1.004, 95% CI 1.002–1.006), host factors (renal transplantation [OR 7.58, 95% CI 3.31–17.40], diabetes mellitus [OR 6.72, 95% CI 5.45–8.28], diabetic ketoacidosis during COVID-19 [OR 4.41, 95% CI 2.03–9.60]), and rural residence (OR 2.88, 95% CI 2.12–3.79), significantly associated with CAM. Mortality rate at 12 weeks was 32.2% (473/1,471). We emphasize the judicious use of COVID-19 therapies and optimal glycemic control to prevent CAM.