Multicenter Case-Control Study of COVID-19-Associated Mucormycosis Outbreak, India

• Published in: Emerging infectious diseases Vol. 29; no. 1; pp. 8 - 19
• Main Authors: Muthu, Valliappan, Agarwal, Ritesh, Rudramurthy, Shivaprakash Mandya, Thangaraju, Deepak, Shevkani, Manoj Radhakishan, Patel, Atul K, Shastri, Prakash Srinivas, Tayade, Ashwini, Bhandari, Sudhir, Gella, Vishwanath, Savio, Jayanthi, Madan, Surabhi, Hallur, Vinay Kumar, Maturu, Venkata Nagarjuna, Srinivasan, Arjun, Sethuraman, Nandini, Sibia, Raminder Pal Singh, Pujari, Sanjay, Mehta, Ravindra, Singhal, Tanu, Saxena, Puneet, Gupta, Varsha, Nagvekar, Vasant, Prayag, Parikshit, Patel, Dharmesh, Xess, Immaculata, Savaj, Pratik, Panda, Naresh, Rajagopal, Gayathri Devi, Parwani, Riya Sandeep, Patel, Kamlesh, Deshmukh, Anuradha, Vyas, Aruna, Sistla, Srinivas Kishore, Padaki, Priyadarshini A, Ramar, Dharshni, Sarkar, Saurav, Rachagulla, Bharani, Vallandaramam, Pattabhiraman, Premachandran, Krishna Prabha, Pawar, Sunil, Gugale, Piyush, Hosamani, Pradeep, Dutt, Sunil Narayan, Nair, Satish, Kalpakkam, Hariprasad, Badhwar, Sanjiv, Kompella, Kiran Kumar, Singla, Nidhi, Navlakhe, Milind, Prayag, Amrita, Singh, Gagandeep, Dhakecha, Poorvesh, Chakrabarti, Arunaloke
• Format: Journal Article
• Language: English
• Published: United States U.S. National Center for Infectious Diseases 01.01.2023; Centers for Disease Control and Prevention
• Subjects: Case studies; Case-Control Studies; Confounding (Statistics); coronavirus disease; COVID-19; COVID-19 - epidemiology; Diabetes; Diabetic ketoacidosis; Drug dosages; Epidemics; Fungal infections; Hematology; Histopathology; Humans; Illnesses; India; India - epidemiology; invasive molds; Microscopy; Missing data; Monoclonal antibodies; Mortality; Mucorales; Mucormycosis; Mucormycosis - diagnosis; Mucormycosis - epidemiology; Multicenter Case–Control Study of COVID-19–Associated Mucormycosis Outbreak, India; Multicenter Studies as Topic; Outbreaks; Pandemics; Patient outcomes; Patients; Regression analysis; Risk factors; Severe acute respiratory syndrome coronavirus 2; Statistics; Variables; Zygomycosis; India; viruses; invasive molds; Rhizopus; zoonoses; respiratory infections; India; Zygomycosis; COVID-19; Mucormycosis; Mucorales; SARS-CoV-2; fungi; severe acute respiratory syndrome coronavirus 2; aspergillosis; coronavirus disease
• ISSN: 1080-6040; 1080-6059
• DOI: 10.3201/eid2901.220926

We performed a case–control study across 25 hospitals in India for the period of January–June 2021 to evaluate the reasons for an COVID-19–associated mucormycosis (CAM) outbreak. We investigated whether COVID-19 treatment practices (glucocorticoids, zinc, tocilizumab, and others) were associated with CAM. We included 1,733 cases of CAM and 3,911 age-matched COVID-19 controls. We found cumulative glucocorticoid dose (odds ratio [OR] 1.006, 95% CI 1.004–1.007) and zinc supplementation (OR 2.76, 95% CI 2.24–3.40), along with elevated C-reactive protein (OR 1.004, 95% CI 1.002–1.006), host factors (renal transplantation [OR 7.58, 95% CI 3.31–17.40], diabetes mellitus [OR 6.72, 95% CI 5.45–8.28], diabetic ketoacidosis during COVID-19 [OR 4.41, 95% CI 2.03–9.60]), and rural residence (OR 2.88, 95% CI 2.12–3.79), significantly associated with CAM. Mortality rate at 12 weeks was 32.2% (473/1,471). We emphasize the judicious use of COVID-19 therapies and optimal glycemic control to prevent CAM.