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Sahu M, Shah M, Mallela VR, Kola VR, Boorugu HK, Punjani AAR, Kumar RV, Kumar S, Manusrut M, Kumar SCR, Rathod R, Babu DM, Gonuguntla HK, Yedlapati GK, Mallu GR, Reddy YS, Reddy VV, Alwala S, Bongu VK, Kamalesh A, Kumar RNK, Jaishetwar GS, Bagapally RS, Srinivas JS, Balasubramaniam A, Rajagopalan BK, Pullikanti B, Prakasham SP, Nimmala P, Nagaraju B, Sahoo PR. COVID-19 associated multisystemic mucormycosis from India: a multicentric retrospective study on clinical profile, predisposing factors, cumulative mortality and factors affecting outcome. Infection 2022; 51:407-416. [PMID: 35922704 PMCID: PMC9362592 DOI: 10.1007/s15010-022-01891-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 07/14/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE The clinical course of COVID-19 has been complicated by secondary infections, including bacterial and fungal infections. The rapid rise in the incidence of invasive mucormycosis in these patients is very much concerning. COVID-19-associated mucormycosis was detected in huge numbers during the second wave of the COVID-19 pandemic in India, with several predisposing factors indicated in its pathogenesis. This study aimed to evaluate the epidemiology, predisposing factor, cumulative mortality and factors affecting outcomes among the coronavirus disease COVID-19-associated mucormycosis (CAM). METHODS A multicenter retrospective study across three tertiary health care centers in Southern part of India was conducted during April-June 2021. RESULTS Among the 217 cases of CAM, mucormycosis affecting the nasal sinuses was the commonest, affecting 95 (44%) of the patients, orbital extension seen in 84 (38%), pulmonary (n = 25, 12%), gastrointestinal (n = 6, 3%), isolated cerebral (n = 2) and disseminated mucormycosis (n = 2). Diabetes mellitus, high-dose systemic steroids were the most common underlying disease among CAM patients. The mucormycosis-associated case-fatality at 6 weeks was 14%, cerebral or GI or disseminated mucormycosis had 9 times higher risk of death compared to other locations. Extensive surgical debridement along with sequential antifungal drug treatment improved the survival in mucormycosis patients. CONCLUSION Judicious and appropriate management of the predisposing factor and factors affecting mortality associated with CAM with multi-disciplinary approach and timely surgical and medical management can be much helpful in achieving a successful outcome.
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Affiliation(s)
- Monalisa Sahu
- Department of Infectious Diseases, Yashoda Hospital, Secunderabad, Hyderabad, 500003, India.
| | - Milap Shah
- Department of Pathology, Yashoda Hospital, Hyderabad, India
| | | | - Venkat Raman Kola
- Department of Critical Care Medicine, Yashoda Hospital, Secunderabad, Hyderabad, 500003, India
| | | | | | - R Vijay Kumar
- Department of ENT and Head and Neck Surgery, Yashoda Hospital, Hyderabad, India
| | - Sairaj Kumar
- Department of ENT and Head and Neck Surgery, Yashoda Hospital, Hyderabad, India
| | - Manusrut Manusrut
- Department of ENT and Head and Neck Surgery, Yashoda Hospital, Hyderabad, India
| | - S Ch Raghu Kumar
- Department of ENT and Head and Neck Surgery, Yashoda Hospital, Hyderabad, India
| | - Rajkumar Rathod
- Department of Laboratory and Transfusion Medicine, Yashoda Hospital, Hyderabad, 500003, India
| | - Dilip M Babu
- Department of Nephrology, Yashoda Hospital Somajiguda, Hyderabad, 500028, India
| | | | | | | | - Y Sai Reddy
- Department of Pulmonology, Yashoda Hospital, Secunderabad, Hyderabad, 500003, India
| | - Vedire Vishnu Reddy
- Department of Anaesthesia, Yashoda Hospital, Secunderabad, Hyderabad, 500003, India
| | - Surendar Alwala
- Department of Radiodiagnosis, Yashoda Hospital, Secunderabad, Hyderabad, 500003, India
| | | | - A Kamalesh
- Department of Medicine, Yashoda Hospital, Hyderabad, India
| | - R N Komal Kumar
- Department of Neurology, Yashoda Hospital, Secunderabad, Hyderabad, 500003, India
| | - Ganesh S Jaishetwar
- Department of Hematology and BMT, Yashoda Hospital, Somajiguda, Hyderabad, 500082, India
| | - Ravi Shankar Bagapally
- Department of Gastroenterology, Yashoda Hospital, Secunderabad, Hyderabad, 500003, India
| | - Jammula S Srinivas
- Department of Plastic and Cosmetic Surgery, Yashoda Hospital, Secunderabad, Hyderabad, 500003, India
| | | | | | | | | | - Pavani Nimmala
- Department of Microbiology, Yashoda Hospital, Hyderabad, India
| | - Barla Nagaraju
- Department of Pulmonology, Yashoda Hospital, Secunderabad, Hyderabad, 500003, India
| | - Pradipt R Sahoo
- Department of ENT and Head and Neck Surgery, Yashoda Hospital, Hyderabad, India
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