Mucormycosis and COVID-19: An epidemic within a pandemic in India

Mycoses. 2021 Oct;64(10):1253-1260. doi: 10.1111/myc.13353. Epub 2021 Jul 24.

Abstract

Importance: Coronavirus disease (COVID-19) causes an immunosuppressed state and increases risk of secondary infections like mucormycosis. We evaluated clinical features, predisposing factors, diagnosis and outcomes for mucormycosis among patients with COVID-19 infection.

Methods: This prospective, observational, multi-centre study included 47 consecutive patients with mucormycosis, diagnosed during their course of COVID-19 illness, between January 3 and March 27, 2021. Data regarding demography, underlying medical conditions, COVID-19 illness and treatment were collected. Clinical presentations of mucormycosis, imaging and biochemical characteristics and outcome were recorded.

Results: Of the 2567 COVID-19 patients admitted to 3 tertiary centres, 47 (1.8%) were diagnosed with mucormycosis. Mean age was 55 ± 12.8years, and majority suffered from diabetes mellitus (n = 36, 76.6%). Most were not COVID-19 vaccinated (n = 31, 66.0%) and majority (n = 43, 91.5%) had developed moderate-to-severe pneumonia, while 20 (42.6%) required invasive ventilation. All patients had received corticosteroids and broad-spectrum antibiotics while most (n = 37, 78.7%) received at least one anti-viral medication. Mean time elapsed from COVID-19 diagnosis to mucormycosis was 12.1 ± 4.6days. Eleven (23.4%) subjects succumbed to their disease, mostly (n = 8, 72.7%) within 7 days of diagnosis. Among the patients who died, 10 (90.9%) had pre-existing diabetes mellitus, only 2 (18.2%) had received just one vaccine dose and all developed moderate-to-severe pneumonia, requiring oxygen supplementation and mechanical ventilation.

Conclusions: Mucormycosis can occur among COVID-19 patients, especially with poor glycaemic control, widespread and injudicious use of corticosteroids and broad-spectrum antibiotics, and invasive ventilation. Owing to the high mortality, high index of suspicion is required to ensure timely diagnosis and appropriate treatment in high-risk populations.

Keywords: COVID-19; Mucormycosis; coronavirus disease 2019; diabetes mellitus; systemic corticosteroids.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Adrenal Cortex Hormones / adverse effects*
  • Adrenal Cortex Hormones / therapeutic use
  • Antifungal Agents / therapeutic use
  • Antiviral Agents / therapeutic use
  • COVID-19 / epidemiology*
  • COVID-19 / mortality
  • COVID-19 Drug Treatment
  • Coinfection / microbiology
  • Diabetes Complications
  • Diabetes Mellitus / pathology
  • Humans
  • India / epidemiology
  • Middle Aged
  • Mucormycosis / drug therapy
  • Mucormycosis / epidemiology*
  • Mucormycosis / mortality
  • Prospective Studies
  • Respiration, Artificial / adverse effects*
  • Ventilators, Mechanical / adverse effects

Substances

  • Adrenal Cortex Hormones
  • Antifungal Agents
  • Antiviral Agents