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 Chakrabarti2
, and MucoCovi Network3
, and MucoCovi Network3
Table 3
Characteristics of early and late CAM among patients with COVID-19, India*
| Variables |
Early CAM, n = 29† |
Late CAM, n = 158‡ |
p value |
|---|---|---|---|
| Mean age, y (SD) |
51.8 (14.2) |
57.8 (11.9) |
0.015 |
| Sex | 0.10 | ||
| F | 9 (31.0) | 28 (17.7) | |
| M |
20 (69.0) |
130 (82.3) |
|
| Glucocorticoids |
8 (27.6) |
138 (87.3) |
0.0001 |
| Tocilizumab |
0 |
5 (3.2) |
0.33 |
| Underlying diseases | 0.52 | ||
| COVID-19 only | 11 (37.9) | 50 (31.6) | |
| Diabetes mellitus | 16 (55.2) | 97 (61.4) | |
| Diagnosed during current illness | 6 | 33 | |
| Diabetic ketoacidosis§ | 8 | 8 | |
| Traumatic inoculation: dental surgery, trauma, and burns | 0 | 3 (1.9) | |
| Hematological malignancy | 0 | 2 (1.3) | |
| Renal transplantation | 0 | 3 (1.9) | |
| Other: liver cirrhosis, immunosuppression, and others |
2 (6.9) |
3 (1.9) |
|
| Site of involvement | 0.88 | ||
| Rhino-orbital | 17 (58.7) | 100 (63.3) | |
| Rhino-orbito-cerebral | 8 (27.6) | 36 (22.8) | |
| Pulmonary | 3 (10.3) | 13 (8.2) | |
| Renal | 0 | 1 (0.6) | |
| Other: e.g., cutaneous, stomach | 0 | 5 (3.2) | |
| Disseminated |
1 (3.4) |
3 (1.9) |
|
| Hypoxemia during hospitalization |
9 (31.0) |
65 (41.1) |
0.19 |
| ICU admission |
12 (41.4) |
46 (29.1) |
0.31 |
| Glucocorticoid treatment for COVID-19 | N = 17 | N = 133 | |
| Appropriate | 11 (64.7) | 44 (33.1) | |
| Not indicated | 4 (23.5) | 46 (34.6) | |
| Indicated, but inappropriately high dose |
2 (11.8) |
43 (32.3) |
|
| Treatment | |||
| Liposomal amphotericin B | 26 (89.7) | 110 (71.9) | 0.06 |
| Amphotericin D deoxycholate | 3 (10.3) | 28 (17.7) | 0.33 |
| Posaconazole | 4 (13.8) | 69 (43.7) | 0.02 |
| Isavuconazole |
0 |
19 (12.0) |
0.049 |
| Combined antifungal therapy | 0.004 | ||
| Single antifungal drug | 23 (79.4) | 72 (45.6) | |
| Concurrent | 1 (3.4) | 12 (7.6) | |
| Sequential |
5 (17.2) |
74 (46.8) |
|
| Combined medical and surgical therapy |
18 (62.1) |
113 (71.5) |
0.31 |
| Outcomes | |||
| Death at 6 weeks | 12 (41.4) | 58 (36.7) | 0.63 |
| Death at 12 weeks, n = 170 | 13/22 (59.1) | 62/148 (41.9) | 0.17 |
*Values are no. (%) except as indicated. CAM, COVID-19–associated mucormycosis; COVID-19, coronavirus disease; ICU, intensive care unit. †Early CAM is considered mucormycosis diagnosed <7 days of COVID-19 diagnosis. ‡Late CAM is mucormycosis diagnosed >8 days of COVID-19 diagnosis. §Diabetic ketoacidosis was more frequent among patients with early CAM (p = 0.0001).
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.
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Page updated: August 17, 2021
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