Abstract
Introduction: COVID19 associated mucormycosis (CAM) became a public health problem in India in 2021 . However information about incidence, presentation, prognosis of CAM remains sparseMethods: We describe 100 cases from SPAROS, a prospective observational follow-up study of CAM cases diagnosed in Chandrapur district, India. We use two step cluster analysis using four input variables- blood glucose on admission, diabetes status, glucocorticoid exposure and COVID19 severity- to define three distinct CAM clusters.Results: The incidence of CAM in the general population is 7.1 cases /1000 COVID19 hospitalized cases. Steroid exposure and pre-existing diabetes was present in 76% and 55% respectively. In a median follow up of 18 days, only two deaths were recorded, while 93 were stable. .Glucocorticoids, in particular methylprednisolone, seemed to precipitate CAM. ICU admission was found to predict less extensive surgery.Discussion: We describe three subtypes- COVID 19 associated Diabetes and mucormycosis (CADM), COVID19 associated Classical Mucormycosis (CACM) and COVID19 induced mucormycosis (CIM) . We propose a CAM hypothesis based on SARS CoV2 and Glucose Regulated Protein (GRP 78) dynamicsConclusion: Clinical characteristics, natural course and pathogenesis is different from Mucormycosis in pre-covid era . Our classification, will be handy in CAM management.
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