Epidemiology, clinical presentation and management of COVID-19 associated mucormycosis: A single centre experience from Pune, Western India.
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Dravid Ameet, Kashiva Reema, Khan Zafer, Bande Balasaheb, Memon Danish, Kodre Aparna, Mane Milind, Pawar Vishal, Patil Dattatraya, Kalyani Suraj, Raut Prathamesh, Bapte Madhura, Saldanha Charlotte, Chandak Dinesh, Patil Teerthagouda, Reddy Sateesh, Bhayani Krushnadas, Suresh Laxmi, Dillibabu Vishnu, Srivastava Shipra, Khandelwal Shubham, More Sailee, Shakeel Atif, Pawar Mohit, Nande Pranava, Harshe Amol, Kadam Sagar, Hallikar Sudhir, Kamal Nudrat, Andrabi Danish, Bodhale Sachin, Raut Akshay, Chandrashekhar Sangeeta, Raman Chandrashekhar, Mahajan Uma, Joshi Gaurav, Mane Dilip
Аннотация
METHODS: This retrospective cohort study was conducted at Noble hospital and Research Centre (NHRC), Pune, India, between 1 April, 2020, and 1 August, 2021, to identify CAM patients and assess their management outcomes. The primary endpoint was incidence of all-cause mortality due to CAM.
RESULTS: 59 patients were diagnosed with CAM. Median duration from the first positive COVID-19 RT PCR test to diagnosis of CAM was 17 (IQR: 12,22) days. 90% patients were diabetic with 89% having uncontrolled sugar level (HbA1c >7%). All patients were prescribed steroids during treatment for COVID-19. 56% patients were prescribed steroids for non-hypoxemic, mild COVID-19 (irrational steroid therapy), while in 9%, steroids were prescribed in inappropriately high dose. Patients were treated with a combination of surgical debridement (94%), intravenous liposomal Amphotericin B (91%) and concomitant oral Posaconazole (95.4%). 74.6% patients were discharged after clinical and radiologic recovery while 25.4% died. On relative risk analysis, COVID-19 CT severity index ≥18 (p = .017), presence of orbital symptoms (p = .002), presence of diabetic ketoacidosis (p = .011) and cerebral involvement (p = .0004) were associated with increased risk of death.
CONCLUSIONS: CAM is a rapidly progressive, angio-invasive, opportunistic fungal infection, which is fatal if left untreated. Combination of surgical debridement and antifungal therapy leads to clinical and radiologic improvement in majority of cases.