Multicenter Epidemiologic Study of Coronavirus Disease–Associated Mucormycosis, India

• Published in: Emerging infectious diseases Vol. 27; no. 9; pp. 2349 - 2359
• Main Authors: Patel, Atul, Agarwal, Ritesh, Rudramurthy, Shivaprakash M., Shevkani, Manoj, Xess, Immaculata, Sharma, Ratna, Savio, Jayanthi, Sethuraman, Nandini, Madan, Surabhi, Shastri, Prakash, Thangaraju, Deepak, Marak, Rungmei, Tadepalli, Karuna, Savaj, Pratik, Sunavala, Ayesha, Gupta, Neha, Singhal, Tanu, Muthu, Valliappan, Chakrabarti, Arunaloke
• Format: Journal Article
• Language: English
• Published: United States U.S. National Center for Infectious Diseases 01.09.2021; Centers for Disease Control and Prevention
• Subjects: Antifungal agents; Antifungal Agents - therapeutic use; Bacterial infections; coronavirus disease; Coronaviruses; COVID-19; Diabetes; Disease; Disease transmission; Drug dosages; Epidemics; Epidemiology; Expedited; Fungal infections; Histopathology; Humans; Hypoxemia; India; India - epidemiology; Intensive care; Microscopy; Mortality; Mucormycosis; Mucormycosis - diagnosis; Mucormycosis - drug therapy; Mucormycosis - epidemiology; Multicenter Epidemiologic Study of Coronavirus Disease–Associated Mucormycosis, India; Pandemics; Patient outcomes; Patients; respiratory infections; Retrospective Studies; Risk factors; SARS; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Statistics; India; posaconazole; viruses; isavuconazole; SARS; coronavirus; zoonoses; mucormycosis; respiratory infections; India; COVID-19; amphotericin; epidemiology; SARS-CoV-2; fungi; severe acute respiratory syndrome coronavirus 2; coronavirus disease; diabetes
• ISSN: 1080-6040; 1080-6059; 1080-6059
• DOI: 10.3201/eid2709.210934

During September-December 2020, we conducted a multicenter retrospective study across India to evaluate epidemiology and outcomes among cases of coronavirus disease (COVID-19)-associated mucormycosis (CAM). Among 287 mucormycosis patients, 187 (65.2%) had CAM; CAM prevalence was 0.27% among hospitalized COVID-19 patients. We noted a 2.1-fold rise in mucormycosis during the study period compared with September-December 2019. Uncontrolled diabetes mellitus was the most common underlying disease among CAM and non-CAM patients. COVID-19 was the only underlying disease in 32.6% of CAM patients. COVID-19-related hypoxemia and improper glucocorticoid use independently were associated with CAM. The mucormycosis case-fatality rate at 12 weeks was 45.7% but was similar for CAM and non-CAM patients. Age, rhino-orbital-cerebral involvement, and intensive care unit admission were associated with increased mortality rates; sequential antifungal drug treatment improved mucormycosis survival. The COVID-19 pandemic has led to increases in mucormycosis in India, partly from inappropriate glucocorticoid use.