COVID associated mucormycosis: various trends, effects of treatment and sequelae

Abstract

Background: With second wave of covid-19 pandemic rapid rise in cases of covid associated mucormycosis (CAM) was detected. The primary reason that appears to be facilitating Mucorales spores to germinate in people with COVID-19 is an ideal environment of low oxygen, high blood glucose, acidic medium (metabolic acidosis, diabetic ketoacidosis [DKA], high serum iron levels. Aim of this study is to evaluate the extent of disease, its causative factors, various associations and effect of treatment. Methods: This is a prospective study done on 180 patients. Detailed history and diagnostic nasal endoscopic guided biopsies were taken and sent for histopathological and microbial examination. Computed tomography (CT) and MRI of paranasal sinus, orbit, skull base and brain were done. The data collected was entered in Microsoft excel and analyzed data was presented in form of frequency and percentage shown by bar chart and pie charts. Results: The average age of the patients was 50.53 ± 11.280 years. Majority of patients were male (73.3%). Mean duration of onset was 19.28±11.482 days. The most common presenting symptom was headache( 90%). 98.9% (N=178) patients were diabetics, 52.2% patients were known diabetics, newly diagnosed diabetics were 41.7%. 73.90% patients had history of steroid intake. 39 patients were certified dead with overall 21.7% mortality rate. Conclusions: Increase in mucormycosis in Indian context appears to be an unholy intersection of trinity of COVID-19, Diabetes mellitus and corticosteroid. High suspicion, early diagnosis and rigorous management is the key to favourable prognosis.