COVID-19 Associated Mucormycosis (CAM) - A Case Series from a Tertiary Care Hospital in India

Abstract

Purpose: Coronavirus disease (COVID-19) remains a health concern with new emerging challenges as rise of opportunistic mucormycosis infections in COVID-19 patients has been found to increase morbidity and mortality. Even though rare, COVID-19 associated mucormycosis has been reported from across the world. We present a retrospective cases series of 132 patients diagnosed as COVID-19 associated mucormycosis in a tertiary care hospital in North India during May 9th to 30th 2021. Materials and Methods: Our 1500 bed tertiary care hospital is one of the partners in the Mycotic Infections in COVID-19 (MUNCO) registry, Albert Einstein College of Medicine, Bronx, New York. Data were collected in the REDCap database. Profile of the patients has been presented according to demographic profile, comorbidities, laboratory parameters, ICU admission, oxygen support and treatment outcomes. Analysis of risk factors for mortality has been undertaken along with a prediction model for mortality. Result: The proportion of males and females was 72.7% and 27.3% respectively. The mean age of the study subjects was 53.1 years. The major comorbidity was Diabetes (57.6%) followed by Hypertension (40.9%) and Coronary artery disease (11.4%). About 13% patients used long term corticosteroid. Further, 70.5% patients required an ICU admission and 47.0% patients required oxygen support whereas ventilator requirement was for 13.6% patients. Overall death rate of mucormycosis patients was 16.7%. The risk factors identified for death were raised levels of CRP >73, Ferritin >358, SGOT >39 and Creatinine >1.15 as well as oxygen requirement. Conclusion: Clinicians must examine the possibility of concomitant fungal infection in COVID-19 patients especially who are geriatric or comorbid with Diabetes Mellitus. Those with raised levels of CRP, Ferritin, SGOT and Creatinine levels as well as those needing oxygen need to be vigilantly monitored to minimize the risk of mortality.