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Ramaswami A, Sahu AK, Kumar A, Suresh S, Nair A, Gupta D, Chouhan R, Bhat R, Mathew R, Majeed JA, Aggarwal P, Nayer J, Ekka M, Thakar A, Singh G, Xess I, Wig N. COVID-19-associated mucormycosis presenting to the Emergency Department-an observational study of 70 patients. QJM 2021; 114:464-470. [PMID: 34254132 PMCID: PMC8420631 DOI: 10.1093/qjmed/hcab190] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Mucormycosis (MM) is a deadly opportunistic fungal infection and a large surge in COVID-19-associated mucormycosis (CAM) is occurring in India. AIM Our aim was to delineate the clinico-epidemiological profile and identify risk factors of CAM patients presenting to the Emergency Department (ED). DESIGN This was a retrospective, single-centre, observational study. METHODS We included patients who presented with clinical features or diagnosed MM and who were previously treated for COVID-19 in last 3 months of presentation (recent COVID-19) or currently being treated for COVID-19 (active COVID-19). Information regarding clinical features of CAM, possible risk factors, examination findings, diagnostic workup including imaging and treatment details were collected. RESULTS Seventy CAM patients (median age: 44.5 years, 60% males) with active (75.7%) or recent COVID-19 (24.3%) who presented to the ED in between 6 May 2021 and 1 June 2021, were included. A median duration of 20 days (interquartile range: 13.5-25) was present between the onset of COVID-19 symptoms and the onset of CAM symptoms. Ninety-three percent patients had at least one risk factor. Most common risk factors were diabetes mellitus (70%) and steroid use for COVID-19 disease (70%). After clinical, microbiological and radiological workup, final diagnosis of rhino-orbital CAM was made in most patients (68.6%). Systemic antifungals were started in the ED and urgent surgical debridement was planned. CONCLUSION COVID-19 infection along with its medical management have increased patient susceptibility to MM.
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Affiliation(s)
- A Ramaswami
- Department of Emergency Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - A K Sahu
- Department of Emergency Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - A Kumar
- Department of Emergency Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - S Suresh
- Department of Emergency Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - A Nair
- Department of Emergency Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - D Gupta
- Department of Emergency Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - R Chouhan
- Department of Emergency Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - R Bhat
- Department of Emergency Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - R Mathew
- Department of Emergency Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - J A Majeed
- Department of Emergency Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - P Aggarwal
- Department of Emergency Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - J Nayer
- Department of Emergency Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - M Ekka
- Department of Emergency Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - A Thakar
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - G Singh
- Department of Microbiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - I Xess
- Department of Microbiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - N Wig
- Department of Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
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