DOI: http://dx.doi.org/10.18203/issn.2454-5929.ijohns20221056

Factors contributing to poor outcome in COVID associated mucormycosis

Kavita Sachdeva, Stephy M. Tom, Lakshmy V. Raj, Soumya Saini, Mayur V. Kabade, Amrita Shukla

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.


Keywords


Mucormycosis, Comorbidities, Deaths

Full Text:

PDF

References


Kubin CJ, McConville TH, Dietz D, Zucker J, May M, Nelson B, et al. Characterization of Bacterial and Fungal Infections in Hospitalized Patients With Coronavirus Disease 2019 and Factors Associated With Health Care-Associated Infections. Open Forum Infect Dis. 2021;8(6):ofab201.

Song G, Liang G, Liu W. Fungal Co-infections associated with global COVID-19 pandemic: a clinical and diagnostic perspective from China. Mycopathologia. 2020;185(4):599-606.

Paltauf A. Mycosis mucorina. Virchows Arch Pathol Anat Physiol Klin Med. 1885;102:543-64.

Baker RD. Mucormycosis-a new disease? J Am Med Assoc. 1957;163:805-8.

Eucker J, Sezer O, Graf B, Possinger K. Mucormycoses. Mycoses. 2001;44(7):253-60.

Sugar AM. In: Mandell GL, Bennett JE, Dolin R, editors. Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Fifth ed. New York, USA: Churchill Livingstone. 2000.

Singh P. Black fungus: here is a list of states with highest number of mucormycosis cases. Hindustan Times. 2021. Available at: https://www. hindustantimes.com/india-news/blackfungus-states-with-highest-number-ofmucormycosis-cases-101621559394002.html. Accessed on 28 May 2021.

Indian Council of Medical Research. Evidence based advisory in the time of COVID-19 (screening, diagnosis & management of mucormycosis). 2021. Available at: https://www.icmr.gov.in/pdf/covid/ techdoc/Mucormycosis_ADVISORY_FROM_ICMR_In_ COVID19_time.pdf. Accessed on 28 May 2021.

John TM, Jacob CN, Kontoyiannis DP. When uncontrolled diabetes mellitus and severe COVID-19 converge: the perfect storm for mucormycosis. J Fungi. 2021;7:298.

Deutsch PG, Whittaker J, Prasad S. Invasive and non-invasive fungal rhinosinusitisda review and update of the evidence. Medicina. 2019;55:1-14.

Maartens G, Wood MJ. The clinical presentation and diagnosis of invasive fungal infections. J Antimicrob Chemother. 1991;28(13-22):17-44.

Sugar AM. Mucormycosis. Clin Infect Dis. 1992;14:S126-9.

Peterson KL, Wang M, Canalis FR, Abemayor E. Rhinocerebral mucormycosis: evolution of the disease and treatment options. Laryngoscope. 1997;107:855-62.

Smith HW, Kirchner JA. Cerebral mucor-mycosis: a report of 3 cases. Arch Otolaryngol. 1950;68:715-26.