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Das KN, Sharma V, Mohan V, Soni K, Chugh A, Choudhury B, Goyal A. WHO BREF Quality of Life Score as a Prognostic Indicator of Survival in Patients recovered from COVID-19 Associated Rhino-Orbito-Cerebral Mucormycosis. Indian J Otolaryngol Head Neck Surg 2024; 76:3441-3450. [PMID: 39130291 PMCID: PMC11306894 DOI: 10.1007/s12070-024-04723-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 04/19/2024] [Indexed: 08/13/2024] Open
Abstract
Coronavirus disease 2019 (COVID-19)-associated mucormycosis (CAM) has emerged as a formidable infection in patients with COVID-19, this study was designed to assess the QOL in patients with and its predictability for survival in CAM victims. This long term prospective observational study of 290 patients with CAM was conducted over 2 years using a standard questionnaire (the abbreviated World Health Organization Quality of Life questionnaire [WHO-BREF]), Karnofsky performance scale (KPS), palliative performance scale (PPS) and patient rated improvement (PRI) ranging from 0 to 9. Cut-off values of ≤ median score was considered to indicate poor QOL or poor improvement. The overall 2 year survival rate was 78.27% with mean survival time of 763.2 ± 1.2 days (Mean ± S.E) (95% CI: 760.76-765.6). The disease specific mortality was 22.1%. The overall mean QOL was 53.5(10.2) with 51% of population exhibiting poor QOL. Spearman rho correlation showed strong positive correlation between the three QOL scales and PRI (ρ-0.72, p < 0.001). On Cox regression analysis the stage, all four domains of WHO BREF, KPS, and PPS were independent predictors of long term survival in CAM patients. Approximately half of the patients with CAM had poor QOL and poor improvement. All 4 domains of WHO BREF score can be used as a predictor of long term survival in CAM patients. Early recognition is the key to optimal treatment, improved outcomes, and improved QOL in patients with CAM.
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Affiliation(s)
- K. Nidhin Das
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, Jodhpur, India
| | - Vidhu Sharma
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, Jodhpur, India
| | - Vishudh Mohan
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, Jodhpur, India
| | - Kapil Soni
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, Jodhpur, India
| | - Ankita Chugh
- Department of Maxillo-Facial Surgery, All India Institute of Medical Sciences, Jodhpur, India
| | - Bikram Choudhury
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, Jodhpur, India
| | - Amit Goyal
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, Jodhpur, India
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Sahin M, Yilmaz M, Mert A, Naghili B, Ravanbakhsh F, Varshochi M, Darazam IA, Ebrahimi MJ, Moafi M, Tehrani HA, Mahboob A, Rashid N, Khan EA, Hakamifard A, Eser-Karlidag G, Babamahmoodi A, El-Kholy A, Mosawi SH, Albayrak A, Al Ramahi JW, Addepalli SK, Özer Balin Ş, Khan A, Pandya N, Gurbuz E, Sincan G, Azami H, Dumlu R, Khedr R, Ripon RK, Alkan S, Kose Ş, Ceylan B, Erdem H. Factors influencing mortality in COVID-19-associated mucormycosis: The international ID-IRI study. Med Mycol 2024; 62:myae064. [PMID: 38914466 DOI: 10.1093/mmy/myae064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 05/31/2024] [Accepted: 06/23/2024] [Indexed: 06/26/2024] Open
Abstract
The emergence of COVID-19, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), triggered a global pandemic. Concurrently, reports of mucormycosis cases surged, particularly during the second wave in India. This study aims to investigate mortality factors in COVID-19-associated mucormycosis (CAM) cases, exploring clinical, demographic, and therapeutic variables across mostly Asian and partly African countries. A retrospective, cross-sectional analysis of CAM patients from 22 medical centers across eight countries was conducted, focusing on the first 3 months post-COVID-19 diagnosis. Data collected through the ID-IRI included demographics, comorbidities, treatments, and outcomes. A total of 162 CAM patients were included. The mean age was 54.29 ± 13.04 years, with 54% male. Diabetes mellitus (85%) was prevalent, and 91% had rhino-orbital-cerebral mucormycosis. Surgical debridement was performed in 84% of the cases. Mortality was 39%, with advanced age (hazard ratio [HR] = 1.06, [P < .001]), rituximab use (HR = 21.2, P = .05), and diabetic ketoacidosis (HR = 3.58, P = .009) identified as risk factors. The mortality risk increases by approximately 5.6% for each additional year of age. Surgical debridement based on organ involvement correlated with higher survival (HR = 8.81, P < .001). The utilization of rituximab and diabetic ketoacidosis, along with advancing age, has been associated with an increased risk of mortality in CAM patients. A combination of antifungal treatment and surgical intervention has demonstrated a substantial improvement in survival outcomes.
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Affiliation(s)
- Meyha Sahin
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University, Istanbul, Turkey
| | - Mesut Yilmaz
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University, Istanbul, Turkey
| | - Ali Mert
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University, Istanbul, Turkey
| | - Behrouz Naghili
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fatemeh Ravanbakhsh
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mojtaba Varshochi
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ilad Alavi Darazam
- Department of Infectious Diseases and Tropical Medicine, Shahid Beheshti University of Medical Sciences, Loghman Hakim Hospital, Tehran, Iran
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Javad Ebrahimi
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maral Moafi
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamed Azhdari Tehrani
- Department of Hematology-Medical Oncology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amjad Mahboob
- Department of Medicine, Gajju Khan Medical College, Swabi, Pakistan
| | - Naveed Rashid
- Department of Infectious Diseases, Shifa Tameer-e-Millat University and Shifa International Hospital, Islamabad, Pakistan
| | - Ejaz Ahmed Khan
- Department of Infectious Diseases, Shifa Tameer-e-Millat University and Shifa International Hospital, Islamabad, Pakistan
| | - Atousa Hakamifard
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Infectious Diseases, Isfahan University of Medical Sciences, School of Medicine, Isfahan, Iran
| | - Gülden Eser-Karlidag
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Elazig Fethi Sekin City Hospital, Elazig, Turkey
| | - Abdolreza Babamahmoodi
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amani El-Kholy
- Department of Clinical Pathology, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Sayed Hussain Mosawi
- Department of Molecular Research, Medical Sciences Research Center, Ghalib University, Kabul, Afghanistan
| | - Ayşe Albayrak
- Department of Infectious Diseases and Clinical Microbiology, Ataturk University, Faculty of Medicine, Erzurum, Turkey
| | - Jamal Wadi Al Ramahi
- Department of Medicine, Jordan University Hospital, School of Medicine, Amman, Jordan
| | - Syam Kumar Addepalli
- Department of Pharmacology, GITAM Institute of Medical Sciences and Research, Visakhapatnam, Andhra Pradesh, India
| | - Şafak Özer Balin
- Department of Infectious Diseases and Clinical Microbiology, Firat University, Faculty of Medicine, Elazig, Turkey
| | - Asfandiyar Khan
- Department of Cardiology, Lady Reading Hospital, Peshawar, Pakistan
| | - Nirav Pandya
- Consultant Microbiologist & Infection Preventionist Bhailal Amin General Hospital, Vadodara, India
| | - Esra Gurbuz
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Van Training and Research Hospital, Van, Turkey
| | - Gülden Sincan
- Department of Internal Medicine, Ataturk University, Faculty of Medicine, Erzurum, Turkey
| | - Hadia Azami
- Department of Molecular Research, Medical Sciences Research Center, Ghalib University, Kabul, Afghanistan
| | - Rıdvan Dumlu
- Department of Infectious Diseases and Clinical Microbiology, Medipol Mega Hospital, Istanbul, Turkey
| | - Reham Khedr
- Department of Pediatric Oncology, National Cancer Institute, Cairo University, Cairo, Egypt, Department of Pediatric Oncology, Children Cancer Hospital, Cairo, Egypt
| | - Rezaul Karim Ripon
- Department of Public Health and Informatics, Jahangirnagar University, Bangladesh
| | - Sevil Alkan
- Department of Infectious Diseases and Clinical Microbiology, Canakkale Onsekiz Mart University, Faculty of Medicine, Canakkale, Turkey
| | - Şükran Kose
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Tepecik Training and Research Hospital, İzmir, Turkey
| | - Bahadır Ceylan
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University, Istanbul, Turkey
| | - Hakan Erdem
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Gulhane School of Medicine, Ankara, Turkey
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Khodavaisy S, Sarrafnia H, Abdollahi A. Outcomes of Patients with COVID-19 and Fungal Coinfections: A Systematic Review and Meta-Analysis Study. IRANIAN JOURNAL OF PATHOLOGY 2024; 19:136-147. [PMID: 39118795 PMCID: PMC11304463 DOI: 10.30699/ijp.2024.2010087.3160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 11/16/2023] [Indexed: 08/10/2024]
Abstract
Background & Objective Fungal co-infections increase the incidence and mortality of viral respiratory tract infections. This study systematically reviews and conducts a meta-analysis to evaluate the prevalence of COVID-19 patients with fungal coinfections. The aim is to provide a concise overview of the impact of these infections on patient outcomes especially association with risk of mortality, informing future research and optimizing patient management strategies. Methods To identify relevant studies on COVID-19 patients, we conducted a systematic search of databases from the beginning of the year until July 2023, including fungal co-infections, mortality, and sequelae. Eligibility criteria were developed using the PICO framework, and data extraction was carried out separately by two authors using standard techniques. Statistical analysis was performed using the correlation model and differences between studies were evaluated using the I2 test. R and RStudio were used for statistical analysis and visualization. Results We initially identified 6,764 studies, and after checking for equivalence and consistency, 41 studies were included in the final analysis. The overall COVID-19 odds ratio for people who died from fungal infections was 2.65, indicating that patients infected with both COVID-19 and fungal infections had a higher risk of death compared to patients with COVID-19 alone. Specifically, COVID-19-associated pulmonary aspergillosis (CAPA) has a higher odds ratio of 3.36, while COVID-19-associated candidiasis (CAC) has an odds ratio of 1.84, and both are much more associated with death. However, coinfection of the fungus with other fungal species did not show a significant difference in the risk of mortality. Conclusion This study identified CAPA and CAC as the most common infections acquired in healthcare settings. Fungal coinfections may be associated with an increased risk of death in COVID-19 patients.
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Affiliation(s)
- Sadegh Khodavaisy
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Research center for antibiotic stewardship and antimicrobial resistance, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Haleh Sarrafnia
- Faculty of Biological Sciences, Islamic Azad University, Tehran-North Branch, Tehran, Iran
| | - Alireza Abdollahi
- Department of Pathology, School of Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
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Nidhin Das K, Sharma V, Gupta D, Tiwari S, Elhence P, Jain V, Soni K, Goyal A. Predicting intracranial involvement: Unveiling perineural spread in COVID-19-associated mucormycosis, a novel phenomenon. Med Mycol 2024; 62:myad135. [PMID: 38130212 DOI: 10.1093/mmy/myad135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 12/17/2023] [Accepted: 12/20/2023] [Indexed: 12/23/2023] Open
Abstract
This study aimed to investigate the risk factors associated with intracranial involvement in COVID-19-associated mucormycosis (CAM) and to develop a nomogram model for predicting the risk of intracranial involvement, with a specific focus on perineural spread. An ambispective analysis was conducted on 275 CAM patients who received comprehensive treatment. Univariable and multivariable logistic regression analyses were performed to identify independent risk factors, and a nomogram was created based on the results of the multivariable analysis. The performance of the nomogram was evaluated using a receiver operating characteristic (ROC) curve, and the discriminatory capacity was assessed using the area under the curve (AUC). The model's calibration was assessed through a calibration curve and the Hosmer Lemeshow test. In the results, the multivariable logistic regression analysis revealed that age (OR: 1.23, 95% CI 1.06-3.79), HbA1c (OR: 7.168, 95% CI 1.724-25.788), perineural spread (OR: 6.3, 95% CI 1.281-19.874), and the disease stage were independent risk factors for intracranial involvement in CAM. The developed nomogram demonstrated good discriminative capacity with an AUC of 0.821 (95% CI 0.713-0.909) as indicated by the ROC curve. The calibration curve showed that the nomogram was well-calibrated, and the Hosmer Lemeshow test yielded a P-value of 0.992, indicating a good fit for the model. In conclusion, this study found that CAM particularly exhibits perineural spread, which is a predictive factor for intracranial involvement. A nomogram model incorporating age, HbA1c, disease stage, and perineural spread was successfully developed for predicting intracranial involvement in CAM patients in both in-patient and out-patient settings.
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Affiliation(s)
- K Nidhin Das
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, Jodhpur 342005, India
| | - Vidhu Sharma
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, Jodhpur 342005, India
| | - Diksha Gupta
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, Jodhpur 342005, India
| | - Sarbesh Tiwari
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur 342005, India
| | - Poonam Elhence
- Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Jodhpur 342005, India
| | - Vidhi Jain
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur 342005, India
| | - Kapil Soni
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, Jodhpur 342005, India
| | - Amit Goyal
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, Jodhpur 342005, India
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Raina D, Rohilla R, Patwal S, Pandita A. The Second COVID-19 Wave Is a Tsunami With Aftershocks: Mucormycosis Ire as Seen in a Tertiary Care Hospital in Uttarakhand, India. Cureus 2023; 15:e47358. [PMID: 38021725 PMCID: PMC10657149 DOI: 10.7759/cureus.47358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND During the spread of severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) or the coronavirus disease 2019 (COVID-19) pandemic in recent times, an upsurge of invasive fungal infections (IFIs) such as mucormycosis was witnessed by many countries like India. This COVID-19-associated mucormycosis (CAM) has presented as a menace to the already creaking health infrastructure. Clinical manifestations, risk factors, and end clinical outcomes varied for every other region/country. The aim of this study is to delineate and analyze plausible clinical and epidemiological factors and associated predictors of CAM in suspected patients presenting to a tertiary care hospital in Uttarakhand, India, during the second wave of COVID-19 in India. MATERIAL AND METHODS A total of 200 cases of suspected post‑COVID-19 mucormycosis were enrolled. Data were collected taking into account parameters such as hospitalization and ICU admissions during the episode of COVID-19 infection, steroid/antibiotics/oxygen requirement, and comorbidities such as diabetes mellitus, hypertension, or any chronic illness and outcome. RESULTS Participants diagnosed with CAM using KOH examination and fungal culture were analyzed in the study (n=46). The median age of patients included was 48, 73.9% were males, and 26% were females. The major predisposing factor was found to be diabetes mellitus type 2. Our work suggests that the mean duration between COVID-19 episodes and CAM was 11.86 days with a significant statistical association. Oxygen requirement and imprudent use of steroids/antibiotics were also allied with mucormycosis. CONCLUSION The burden of such IFIs is expected to be unveiled in tropical countries during pandemics such as COVID-19, which lead to immunosuppression in masses post-treatment. Comorbidities such as diabetes, chronic kidney disease, and hypertension add to the risk of acquiring other infectious disease. Such times require competent healthcare professionals such as diagnosticians, physicians, and surgeons who are skilled to manage such IFIs timely.
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Affiliation(s)
- Dimple Raina
- Microbiology, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, IND
| | - Ranjana Rohilla
- Microbiology, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, IND
| | - Shiwang Patwal
- Microbiology, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, IND
| | - Ajay Pandita
- Community Medicine, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, IND
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