Epidemiology of Mucormycosis Cases During the Second Wave of COVID-19 in a Tertiary Care Institute in Western Rajasthan, India.

Afzal Hakim,Suman Bhansali,Rita Meena,Manoj Verma,Arun Kumar,Savitri Sharma

doi:10.7759/cureus.22973

Abstract

Introduction: Mucormycosis is a serious but rare fungal infection that showed a sharp surge during the second wave of coronavirus disease 2019 (COVID-19) in India. This study aimed to describe the epidemiological aspects of mucormycosis cases presenting to a tertiary care centre of Western Rajasthan, India, as well as to identify potential risk factors for Mucormycosis.Methods: This cross-sectional descriptive study included 55 patients admitted with a diagnosis of mucormycosis between May and June, 2021, covering the second wave's post-COVID-19 period. Data was collected using a pre-designed, semi-structured questionnaire and hospital case sheets.Results: The mean age of the patients was 54.4±12.53 years, with a male-to-female ratio of 1.89:1. Of the patients, 49% were obese and had no prior history of diabetes. Most COVID-19 patients (54.6%) were treated at home and did not require oxygen support during their COVID-19 course. The majority (89%) were on steroid medication, which was mainly intravenous (93.8%) and lasted 5-10 days in most patients. Rhinoorbitocerebral mucormycosis was the most common type seen in this setting, with symptoms appearing 15-30 days after the onset of COVID-19 symptoms. During the fungal infection, about 61.8% of patients had random blood sugar readings of more than 140 mg/dl. Mortality occurred in 14.5% of patients with mucormycosis. Mortality was observed to be associated with high BMI, raised glycated haemoglobin (HBA1C), and urban residency.Conclusion: Mucormycosis appears to be caused by impaired glycemic control due to pre-existing or new-onset diabetes, which may be exacerbated by unintentional glucocorticoid use. It is necessary to use steroids with caution and maintain care for at least 15-30 days after the onset of COVID-19 symptoms.

Highlights

Mucormycosis is a serious but rare fungal infection that showed a sharp surge during the second wave of coronavirus disease 2019 (COVID-19) in India
Patients were asked about their sociodemographic profile, medical history, personal habits, COVID-19-related information, and detailed treatment history during COVID-19 illness if present, including steroid use, diabetes control, mode of oxygen use, hygiene conditions during oxygen use, and current clinical information about mucormycosis
The current investigation included 55 mucormycosis patients who were all found to have a history of either COVID-19 positive status on reverse transcription-polymerase chain reaction (RT-PCR) (43.6%) or COVID19-like symptoms

Summary

Introduction

Mucormycosis is a serious but rare fungal infection that showed a sharp surge during the second wave of coronavirus disease 2019 (COVID-19) in India. Mucormycosis, or zygomycosis, is a rare disease caused by a filamentous fungus. It's an opportunistic infection that flourishes in persons who have their immune systems impaired. The causative agents are saprophytic fungus from the Phycomycetes class, order Mucorales, and family Mucoraceae. These fungi include Mucor, Rhizopus, Absidia, Cunninghamella, and Apophysomyces elegans [1]. The most common route of infection is inhalation of spores from fungi found in soil or organic debris [2]. The fungus develops swiftly and aggressively in those cases, generating a well-defined fulminant and life-threatening disease. In the majority of instances, it is an acute fungal infection, but chronicity, which is gradual and indolent, has been recorded [3]

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