A case control investigation of COVID-19 associated mucormycosis in India.
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Anand Tanu, Mukherjee Aparna, Satija Aanchal, Velamuri Poonam Sharma, Singh Kh Jitenkumar, Das Madhuchhanda, Josten Kripa, Yadav Pragya D, Sahay Rima R, Keche Archana Y, Nagarkar Nitin M, Gupta Prashant, Himanshu D, Mistry Sejal N, Patel Jimy D, Rao Prajwal, Rohatgi Shalesh, Ghosh Soumitra, Hazra Avijit, Kindo Anupma Jyoti, Annamalai Radha, Rudramurthy Shivaprakash M, Singh Mini P, Shameem Mohammad, Fatima Nazish, Khambholja Janakkumar R, Parikh Sangita, Madkaikar Manisha, Pradhan Vandana D, Kataria Sushila, Sharma Pooja, Panda Samiran, ICMR-Mucormycosis group
Аннотация
METHODS: Eleven study sites were involved across India; archived records since 1st January 2021 till 30th September 2021 were used for trend analysis. The cases and controls were enrolled during 15th June 2021 to 30th September 2021. Data were collected using a semi-structured questionnaire. Among 1211 enrolled participants, 336 were CAM cases and 875 were COVID-19 positive non-mucormycosis controls.
RESULTS: CAM-case admissions reached their peak in May 2021 like a satellite epidemic after a month of in-patient admission peak recorded due to COVID-19. The odds of developing CAM increased with the history of working in a dusty environment (adjusted odds ratio; aOR 3.24, 95% CI 1.34, 7.82), diabetes mellitus (aOR: 31.83, 95% CI 13.96, 72.63), longer duration of hospital stay (aOR: 1.06, 95% CI 1.02, 1.11) and use of methylprednisolone (aOR: 2.71, 95% CI 1.37, 5.37) following adjustment for age, gender, occupation, education, type of houses used for living, requirement of ventilatory support and route of steroid administration. Higher proportion of CAM cases required supplemental oxygen compared to the controls; use of non-rebreather mask (NRBM) was associated as a protective factor against mucormycosis compared to face masks (aOR: 0.18, 95% CI 0.08, 0.41). Genomic sequencing of archived respiratory samples revealed similar occurrences of Delta and Delta derivates of SARS-CoV-2 infection in both cases and controls.
CONCLUSIONS: Appropriate management of hyperglycemia, judicious use of steroids and use of NRBM during oxygen supplementation among COVID-19 patients have the potential to reduce the risk of occurrence of mucormycosis. Avoiding exposure to dusty environment would add to such prevention efforts.