Factors contributing to poor outcome in COVID associated mucormycosis

Abstract

Background: Mucormycosis is an uncommon but a fatal fungal infection that usually affects patients with altered immunity. Mucormycosis is proven to be a life-threatening condition. This occurred in the delta variant epidemic of coronavirus in India. This prompted us to conduct a systematic review of deaths in mucormycosis to know its temporal associations in relation to comorbidities, association with drugs being used in COVID-19 and overall characteristics of patients with its outcome.

Methods: This retrospective study was conducted over 21 deaths out of 140 mucormycosis patients in the tertiary care centre between time period from May 2021 to July 2021. Based on the detailed history, clinical examination, endoscopic examination, blood investigations and radiological investigations, data was collected and analysed.  

Results: In the study 19 patients were post covid and 2 were COVID positive at the time of admission to the hospital. 13 patients were having random blood sugars above 300 and 8 were having below 300 mg/dl. 13 patients had diabetic ketoacidosis. The maximum C-reactive protein (CRP) values was 200 and declined on treatment. The prothrombin time international normalized ratio (PT INR) values range between 0.99 and 1.3. Serum electrolytes were found to be normal in most of the patients. In the present study, 3 patients had electrolyte imbalance not responding to treatment. According to computed tomography/magnetic resonance imaging (CT/MRI) findings,12 had pansinusitis, 3 had pansinusitis with orbital cellulitis, 5 had pansinusitis with cavernous sinus thrombosis and 1 had pansinusitis with mandibular osteomyelitis.

Conclusions: Early diagnosis, prompt treatment of comorbidities and immediate surgical debridement prevents death in mucormycosis patients.