Author:
M Sahu1*, M Shah2, MV Rao3, VR Kola4, HK Boorugu5, AR Punjani6, RV Kumar7, S Kumar8, M Manusrut9, RK Rathod10, HK Gonuguntla11, GK Yedlapati12, GR Mallu13, YS Reddy14, RN KomalKumar15, GS Jaishetwar16, KR Balasubramoniam17, SCR Kumar18, B Nagaraju19, PR Sahoo20
Author address:
1Department of Infectious Diseases, Yashoda Hospital Secunderabad, Hyderabad, India
2Department of Pathology, Yashoda Hospital Secunderabad, Hyderabad, India
3Department of Internal Medicine, Yashoda Hospital Somajiguda, Hyderabad, India
4Department of Critical Care Medicine, Yashoda Hospital Secunderabad, Hyderabad, India
5Department of Internal Medicine, Yashoda Hospital Somajiguda, Hyderabad, India
6Department of Internal Medicine, Yashoda Hospital Somajiguda, Hyderabad, India
7Department of Otorhinolaryngology, Yashoda Hospital Secunderabad, Hyderabad, India
8Department of Otorhinolaryngology, Yashoda Hospital Secunderabad, Hyderabad, India
9Department of Otorhinolaryngology, Yashoda Hospital Somajiguda, Hyderabad, India
10Department of Laboratory Medicine, Yashoda Hospital Secunderabad, Hyderabad, India
11Department of Interventional Pulmonology, Yashoda Hospital Secunderabad, Hyderabad, India
12Department of Interventional Pulmonology, Yashoda Hospital Secunderabad, Hyderabad, India
13Department of Pulmonary Medicine, Yashoda Hospital Secunderabad, Hyderabad, India
14Department of Interventional Pulmonology, Yashoda Hospital Secunderabad, Hyderabad, India
15Department of Neurology, Yashoda Hospital Secunderabad, Hyderabad, India
16Department of Hematology and BMT, Yashoda Hospital Somajiguda, Hyderabad, India
17Department of Cardiothoracic and Vascular Surgery, Yashoda Hospital Secunderabad, Hyderabad, India
18Department of Otorhinolaryngology, Yashoda Hospital Malakpet, Hyderabad, India
19Department of Interventional Pulmonology, Yashoda Hospital Secunderabad, Hyderabad, India
20Department of Otorhinolaryngology, KIMS Hospital , Bhubaneswar, India
Full conference title:
10th Advances Against Aspergillosis and Mucormycosis
Date: 2 February 2022
Abstract:
Purpose:
A multicenter retrospective study across three tertiary health care centers in Hyderabad, India was conducted during April-June 2021, to evaluate the epidemiology, risk factors, cumulative mortality and factors affecting outcome among the coronavirus disease (COVID-19)-associated mucormycosis (CAM).
Methods:
We conducted a retrospective, non-interventional, observational study of the CAM patients, involving three tertiary health care centres in Hyderabad, India. We collected the details of the confirmed CAM cases reported during April 15- March 31, 2021 and followed up the cases for 6 weeks. The ethics committee approval was obtained for the study protocol.
Results:
Demographics
We included 197 consecutive patients of CAM during the study period. About half the cases were in the age group of 37-54 years (n=94, 50%) while 22 (12%) were younger than 37 years and 79 (40%) were older than 55 years. The infecting organism was found to be Rhizopus in 144 cases, (72%) Mucor in 37 cases (19%), Syncephalastrumin 1 case.
Previous COVID-19 infection
The mean time between recovery from prior COVID-19 and onset of mucormycosis was 15.2+9.1 days and ranged from 2-60 days. About half the patients required non-invasive ventilation (NIV) (n=109, 50%), while a further 36 (17%) required mechanical ventilation and 37 (17%) needed supplemental oxygen alone while 35 (16%) did not need any oxygen.
Risk factors for mucormycosis
Majority patients were diabetic (n=179, 88%) of which 27 (14%)were newly diagnosed. Overall, 83% received high dose systemic steroids, 80% had uncontrolled diabetes and 12% had coexisting diabetic ketoacidosis. In addition to diabetes and high dose steroids, patients had other comorbidities such as hypertension (n=66, 34%), prior stroke (n=4, 2%), chronic kidney disease (n=4, 2%) and coronary artery disease (n=9, 4%).
Sites of Mucormycosis
In our patient cohort, mucormycosis involved the nasal sinuses most commonly (n=95, 44%) followed by rhino-orbital (ROM, n=69, 32%), rhino-cerebral (RCM, n=3), rhino-orbito-cerebral (ROCM, n=15, 9%), pulmonary (n=25, 12%), gastrointestinal (n=6, 3%), isolated cerebral (n=2) and disseminated mucormycosis (n=2). In cases with rhino-orbital disease, majority had bilateral involvement (n=152, 70%).
Treatment
The commonest medical treatment offered to patients was a combination of Liposomal amphotericin – B and Posaconazole, in a sequential manner (n=141, 71%) followed by a combination of Liposomal amphotericin – B and Isavuconazole sequentially (n=21, 10%) and lyophilized amphotericin B with Posaconazole sequentially (n=22, 10%). Liposomal amphotericin B, the mainstay of medical management, was administered for a median of 17 days (IQR=11-22 days, range=1-36 days).
Outcomes and survival
A total of 31 (16%) patients died due to mucormycosis in the 6 weeks follow up. Of these, 8 (26%) had sinus involvement, 9 (29%) had ROCM, 6 (19%) had pulmonary involvement, 5 (16%) had GI involvement, 1 (3%) had cerebral, 2 (7%) had disseminated mucormycosis.
Conclusion:
The incidence of mucormycosis has increased immensely during the second wave of COVID in India, and hence the clinicians should be aware and have uptodate knowledge of the risk factors, clinical signs and symptoms, diagnostic modalities and treatment strategies of the various types of CAM.
Abstract Number: 17
Conference Year: 2022
Link to conference website: https://aaam2022.org/
URL Conference abstract: