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Satija A, Anand T, Mukherjee A, Velamuri PS, Singh KJ, Das M, Josten K, Keche AY, Nagarkar NM, Gupta P, Himanshu D, Mistry SN, Patel JD, Rao P, Rohatgi S, Ghosh S, Hazra A, Kindo AJ, Annamalai R, Rudramurthy SM, Singh MP, Shameem M, Fatima N, Khambholja JR, Parikh S, Madkaikar M, Pradhan VD, Bhargava A, Mehata R, Arora RD, Tigga R, Banerjee G, Sonkar V, Malhotra HS, Kumar N, Patil R, Raut CG, Bhattacharyya K, Arthur P, Somu L, Srikanth P, Shah PB, Panda NK, Sharma D, Hasan W, Ahmed A, Bathla M, Solanki S, Doshi H, Kanani Y, Patel N, Shah Z, Tembhurne AK, Rajguru C, Sankhe LR, Chavan SS, Yadav RM, Panda S. Satellite Epidemic of Covid-19 Associated Mucormycosis in India: A Multi-Site Observational Study. Mycopathologia 2023; 188:745-753. [PMID: 37490256 DOI: 10.1007/s11046-023-00770-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 06/17/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Sudden upsurge in cases of COVID-19 Associated Mucormycosis (CAM) following the second wave of the COVID-19 pandemic was recorded in India. This study describes the clinical characteristics, management and outcomes of CAM cases, and factors associated with mortality. METHODS Microbiologically confirmed CAM cases were enrolled from April 2021 to September 2021 from ten diverse geographical locations in India. Data were collected using a structured questionnaire and entered into a web portal designed specifically for this investigation. Bivariate analyses and logistic regression were conducted using R version 4.0.2. RESULTS A total of 336 CAM patients were enrolled; the majority were male (n = 232, 69.1%), literate (n = 261, 77.7%), and employed (n = 224, 66.7%). The commonest presenting symptoms in our cohort of patients were oro-facial and ophthalmological in nature. The median (Interquartile Range; IQR) interval between COVID diagnosis and admission due to mucormycosis was 31 (18, 47) days, whereas the median duration of symptoms of CAM before hospitalization was 10 (5, 20) days. All CAM cases received antifungal treatment, and debridement (either surgical or endoscopic or both) was carried out in the majority of them (326, 97.02%). Twenty-three (6.9%) of the enrolled CAM cases expired. The odds of death in CAM patients increased with an increase in HbA1c level (aOR: 1.34, 95%CI: 1.05, 1.72) following adjustment for age, gender, education and employment status. CONCLUSION A longer vigil of around 4-6 weeks post-COVID-19 diagnosis is suggested for earlier diagnosis of CAM. Better glycemic control may avert mortality in admitted CAM cases.
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Affiliation(s)
| | - Tanu Anand
- Indian Council of Medical Research, New Delhi, India
| | | | | | | | | | - Kripa Josten
- Indian Council of Medical Research, New Delhi, India
| | | | | | | | - D Himanshu
- King George's Medical University, Lucknow, India
| | - Sejal N Mistry
- Pandit Deendayal Upadhyay Medical College, Rajkot, India
| | - Jimy D Patel
- Pandit Deendayal Upadhyay Medical College, Rajkot, India
| | - Prajwal Rao
- Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, India
| | - Shalesh Rohatgi
- Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, India
| | - Soumitra Ghosh
- Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Avijit Hazra
- Institute of Post Graduate Medical Education and Research, Kolkata, India
| | | | - Radha Annamalai
- Sri Ramachandra Medical College and Research Institute, Chennai, India
| | | | - Mini P Singh
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mohammad Shameem
- Jawaharlal Nehru Medical College Aligarh Muslim University, Aligarh, India
| | - Nazish Fatima
- Jawaharlal Nehru Medical College Aligarh Muslim University, Aligarh, India
| | | | | | | | | | | | - Rupa Mehata
- All India Institute of Medical Sciences, Raipur, India
| | | | - Richa Tigga
- All India Institute of Medical Sciences, Raipur, India
| | | | - Vijay Sonkar
- King George's Medical University, Lucknow, India
| | | | - Neeraj Kumar
- King George's Medical University, Lucknow, India
| | - Rajashri Patil
- Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, India
| | | | | | - Preetam Arthur
- Sri Ramachandra Medical College and Research Institute, Chennai, India
| | - L Somu
- Sri Ramachandra Medical College and Research Institute, Chennai, India
| | - Padma Srikanth
- Sri Ramachandra Medical College and Research Institute, Chennai, India
| | - Pankaj B Shah
- Sri Ramachandra Medical College and Research Institute, Chennai, India
| | - Naresh K Panda
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Dipti Sharma
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Wasil Hasan
- Jawaharlal Nehru Medical College Aligarh Muslim University, Aligarh, India
| | - Aftab Ahmed
- Jawaharlal Nehru Medical College Aligarh Muslim University, Aligarh, India
| | | | | | | | - Yash Kanani
- Smt. NHL Municipal Medical College, Ahmedabad, India
| | | | | | | | - Chhaya Rajguru
- Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, India
| | - Lalitkumar R Sankhe
- Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, India
| | - Shrinivas S Chavan
- Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, India
| | | | - Samiran Panda
- Indian Council of Medical Research, New Delhi, India.
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Anand T, Mukherjee A, Satija A, Velamuri PS, Singh KJ, Das M, Josten K, Yadav PD, Sahay RR, Keche AY, Nagarkar NM, Gupta P, Himanshu D, Mistry SN, Patel JD, Rao P, Rohatgi S, Ghosh S, Hazra A, Kindo AJ, Annamalai R, Rudramurthy SM, Singh MP, Shameem M, Fatima N, Khambholja JR, Parikh S, Madkaikar M, Pradhan VD, Kataria S, Sharma P, Panda S, Shete AM, Majumdar T, Abraham P, Bhargava A, Mehata R, Arora RD, Tigga R, Banerjee G, Sonkar V, Malhotra HS, Kumar N, Patil R, Raut CG, Bhattacharyya K, Arthur P, Somu L, Srikanth P, Panda NK, Sharma D, Hasan W, Ahmed A, Bathla M, Solanki S, Doshi H, Kanani Y, Patel N, Shah Z, Tembhurne AK, Rajguru C, Sankhe LR, Chavan SS, Yadav RM, Deswal V, Kumar K. A case control investigation of COVID-19 associated mucormycosis in India. BMC Infect Dis 2022; 22:856. [PMID: 36384482 PMCID: PMC9667849 DOI: 10.1186/s12879-022-07844-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 11/04/2022] [Indexed: 11/17/2022] Open
Abstract
Background Increased occurrence of mucormycosis during the second wave of COVID-19 pandemic in early 2021 in India prompted us to undertake a multi-site case–control investigation. The objectives were to examine the monthly trend of COVID-19 Associated Mucormycosis (CAM) cases among in-patients and to identify factors associated with development of CAM. Methods Eleven study sites were involved across India; archived records since 1st January 2021 till 30th September 2021 were used for trend analysis. The cases and controls were enrolled during 15th June 2021 to 30th September 2021. Data were collected using a semi-structured questionnaire. Among 1211 enrolled participants, 336 were CAM cases and 875 were COVID-19 positive non-mucormycosis controls. Results CAM-case admissions reached their peak in May 2021 like a satellite epidemic after a month of in-patient admission peak recorded due to COVID-19. The odds of developing CAM increased with the history of working in a dusty environment (adjusted odds ratio; aOR 3.24, 95% CI 1.34, 7.82), diabetes mellitus (aOR: 31.83, 95% CI 13.96, 72.63), longer duration of hospital stay (aOR: 1.06, 95% CI 1.02, 1.11) and use of methylprednisolone (aOR: 2.71, 95% CI 1.37, 5.37) following adjustment for age, gender, occupation, education, type of houses used for living, requirement of ventilatory support and route of steroid administration. Higher proportion of CAM cases required supplemental oxygen compared to the controls; use of non-rebreather mask (NRBM) was associated as a protective factor against mucormycosis compared to face masks (aOR: 0.18, 95% CI 0.08, 0.41). Genomic sequencing of archived respiratory samples revealed similar occurrences of Delta and Delta derivates of SARS-CoV-2 infection in both cases and controls. Conclusions Appropriate management of hyperglycemia, judicious use of steroids and use of NRBM during oxygen supplementation among COVID-19 patients have the potential to reduce the risk of occurrence of mucormycosis. Avoiding exposure to dusty environment would add to such prevention efforts. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07844-y.
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