COVID-19 Associated Mucormycosis

Abstract This case series explores Covid-19 associated Mucormycosis (CAM), its risk factors, clinical features and outcomes from a tertiary centre in Maharashtra, India, during the second wave of COVID-19. Methods: A retrospective, observational case series of 104 consecutive patients admitted to the hospital at various stages of complications of CAM, during the second wave of the COVID-19 pandemic (Jan’21-Apr’21). The diagnosis was confirmed using Potassium hydroxide wet mount (KOH), histopathology, fungal culture, and Cone-Beam Computed Tomography(CBCT). Results: There were 81% men, mean age of 49 ± 12.4 years, and all patients had a history of corticosteroids usage, 82% had a prior diagnosis of diabetes mellitus (DM) and the rest were newly diagnosed. Diagnosis of mucormycosis was confirmed on 2 modalities in 71%; KOH and histopathology in 31 (30%), and fungal culture with KOH and histopathology together detected 25 (24%). 9% were diagnosed exclusively with CBCT. Patients with prior DM had higher morbidity OR 8.30 [95% CI: 2.12, 32.5; p=0.002] and mortality OR 13.23 [95% CI: 1.67, 104.7; p=0.014] than non-DM patients. Mortality was higher in patients with rhino + orbital involvement than patients with rhino + maxillary involvement [OR 8.37 [95% CI: 1.52, 46.09; p=0.014]. Conclusion: Diabetes remained the highest risk factor for the development of CAM in patients with COVID-19 on corticosteroids, with high mortality and morbidity. Timely medical and surgical interventions and multi-disciplinary approaches could potentially reduce mucormycosis-associated mortality. Among the diagnostic modalities, detection using CBCT may increase the diagnostic yield in patients not detected in other modalities.