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Volume 27, Number 9—September 2021
Research

Multicenter Epidemiologic Study of Coronavirus Disease–Associated Mucormycosis, India

Atul Patel1, Ritesh Agarwal12, Shivaprakash M. Rudramurthy, Manoj Shevkani, Immaculata Xess, Ratna Sharma, Jayanthi Savio, Nandini Sethuraman, Surabhi Madan, Prakash Shastri, Deepak Thangaraju, Rungmei Marak, Karuna Tadepalli, Pratik Savaj, Ayesha Sunavala, Neha Gupta, Tanu Singhal, Valliappan Muthu, Arunaloke Chakrabarti2Comments to Author , and MucoCovi Network3
Author affiliations: Sterling Hospital, Ahmedabad, India (A Patel); Postgraduate Institute of Medical Education & Research, Chandigarh, India (R. Agarwal, S.M. Rudramurthy, V. Muthu, A. Chakrabarti); Avaron Hospital, Ahmedabad (M. Shevkani); All India Institute of Medical Science, New Delhi, India (I. Xess); Apollo Hospital, Hyderabad, India (R. Sharma); St. John’s Medical College, Bengaluru, India (J. Savio); Apollo Hospital, Chennai, India (N. Sethuraman); Care Institute of Medical Sciences, Ahmedabad (S. Madan); Sir Ganga Ram Hospital, New Delhi (P. Shastri); Kovai Medical Centre and Hospital, Coimbatore, India (D. Thangaraju); Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India (R. Marak); All India Institute of Medical Sciences, Bhopal, India (K. Tadepalli); Venus Hospital, Surat, India (P. Savaj); Hinduja Hospital, Mumbai, Maharashtra, India (A. Sunavala); Medanta The Medicity, Gurgaon, India (N. Gupta); Kokilaben Hospital, Mumbai, Maharashtra, India (T. Singhal)

Main Article

Table 1

Baseline characteristics among patients with mucormycosis, with and without COVID-19, India*

Variables CAM, n = 187 Non-CAM, n = 100 p value
Mean age, y (SD)
 56.9 (12.5)
 46.9 (16.4)
 0.0001
Sex 0.003
M 150 (80.2) 64 (64.0)
F
 37 (19.8)
 36 (36.0)
Underlying disease 0.0001
  None 0 19 (19.0)
  COVID-19 only 61 (32.6) 0
    Glucocorticoids for COVID-19 48/61 (78.7) NA
  Diabetes mellitus 113 (60.4) 67 (67.0)
  Traumatic inoculation (dental surgery, trauma, and burns) 3 (1.6) 9 (9.0)
  Hematological malignancy 2 (1.1) 2 (2)
  Renal transplantation 3 (1.6) 0
  Other†
 5 (2.7)
 3 (3)
Glucocorticoids
 146 (78.1)
 6 (6.0)
 0.0001
Site of involvement
  Rhino-orbital 117 (62.6) 50 (50.0) 0.07
  Rhino-orbito-cerebral 44 (23.5) 34 (34.0) 0.07
  Pulmonary 16 (8.6) 6 (6.0) 0.42
  Renal 1 (0.5) 1 (1.0) 0.66
  Other (e.g., cutaneous, stomach) 5 (2.7) 9 (9.0) 0.03
  Disseminated
 4 (2.1)
 0
 0.41
Microscopy 0.10
  Negative smear 30 (16.0) 10 (10.0)
  Aseptate hyphae 153 (81.8) 84 (84.0)
  Septate hyphae 1 (0.5) 0
  Septate and aseptate hyphae
 3 (1.6)
 6 (6.0)
Culture 0.04
No growth 87 (46.5) 61 (61.0)
  Mucorales 99 (52.9) 37 (37.0)
  Mucorales and Aspergillus species 1 (0.5) 1 (1.0)
  Aspergillus species
 0
 1 (1.0)
Histopathology diagnostic of mucormycosis‡
 143/155 (92.3)
 37/44 (84.1)
 0.10
Management and outcome
Hypoxemia during hospitalization 74 (39.6) 12 (12.0) 0.0001
Admission to the intensive care unit 58 (31.0) 9 (9.0) 0.0001
Treatment
  Liposomal amphotericin B 136 (72.7) 84 (84) 0.002
  Amphotericin D deoxycholate 31 (16.6) 5 (5.0) 0.005
  Posaconazole 73 (39.0) 14 (14.0) 0.0001
  Isavuconazole 19 (10.2) 2 (2.0) 0.01
Combined antifungal therapy 0.0001
  Single antifungal drug 95 (50.8) 88 (88.0)
  Concurrent 13 (7.0) 1 (1.0)
  Sequential 79 (42.5) 11 (11.0)
Combined medical and surgical therapy 131 (70.1) 73 (73.0) 0.60
Outcome
  Death <6 weeks 70 (37.4) 40 (40.0) 0.67
  Death <12 weeks (n = 256) 75/170 (44.1) 42/86 (48.8) 0.51

*Values are no. (%) except as indicated. CAM, COVID-19–associated mucormycosis; COVID-19, coronavirus disease; NA, not applicable. †Includes liver cirrhosis, immunosuppression, and malignancies. ‡Histopathological examination was performed in 199 cases, 155 in the CAM group and 44 non-CAM groups.

Main Article

1These first authors contributed equally to this article.

2These senior authors contributed equally to this article.

3Members are listed at the end of this article.

Page created: June 02, 2021
Page updated: August 17, 2021
Page reviewed: August 17, 2021
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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