ABSTRACT
BACKGROUND: COVID-19 associated mucormycosis (CAM) has been known as one of the most severe post-COVID morbidities. OBJECTIVES: To describe CAM cases, identify possible risk factors, and report outcomes of patients. METHODS: This retrospective study was performed in Amir-Alam Hospital, Tehran, Iran between February 2020 and September 2021. Patients with mucormycosis who had an active or previous diagnosis of COVID-19 have been included. RESULTS: Of 94 patients with mucormycosis, 52 (33 men and 19 women; mean age: 57.0 ± 11.82 years) were identified with an active or history of COVID-19. Rhino-orbital, rhino maxillary, rhino-orbito cerebral subtypes of mucormycosis were detected in 6 (11.5%), 18(34.6%), and 28(53.8%) patients. As a control group, 130 (69 men and 61 women; mean age: 53.10 ± 14.49 years) random RT-PCR-confirmed COVID-19 patients without mucormycosis have been included. The mean interval between COVID-19 diagnosis and initial mucormycosis symptoms was 16.63 ± 8.4 days (range 0-51). Those in the CAM group had a significantly more severe course of COVID-19 (OR = 3.60, P-value < 0.01). Known history of previous diabetes mellitus (OR = 7.37, P-value < 0.01), smoking (OR = 4.55, P-value < 0.01), and history of receiving high-dose corticosteroid pulse therapy because of more severe COVID-19 (P-value = 0.022) were found as risk factors. New-onset post-COVID hyperglycemia was lower in the CAM group (46.2% vs. 63.8%; OR = 0.485, P-value = 0.028). After treatment of the CAM group, 41(78.8%) of patients recovered from mucormycosis. The mean ages of the expired patients in the CAM group were significantly higher than those who recovered from mucormycosis (66.18 ± 9.56 vs. 54.56 ± 11.22 years; P < 0.01); and COVID-19 disease was more severe (P = 0.046). CONCLUSION: Either active or history of COVID-19 can cause an increase in the risk of mucormycosis development. Some of the most important risk factors are the medical history of diabetes mellitus, smoking, and high-dose corticosteroid therapy. CAM is important possible comorbidity related to COVID-19, which could make the post-COVID conditions more complicated. More research and studies with greater sample sizes among different ethnicities are needed to explore the association between COVID-19 and mucormycosis.
Subject(s)
COVID-19 , Mucormycosis , Adult , Aged , Female , Humans , Male , Middle Aged , Adrenal Cortex Hormones , COVID-19/epidemiology , COVID-19 Testing , Iran/epidemiology , Mucormycosis/diagnosis , Mucormycosis/epidemiology , Mucormycosis/complications , Retrospective Studies , Risk FactorsABSTRACT
BACKGROUND: In Covid-19 infection, leukopenia, inflammation, and elevated liver enzymes are found in most patients. Also, vitamin D deficiency attenuates the immune system and predisposes a person to being more susceptible to infection. In this context, we aimed to evaluate vitamin D, electrolytes, complete blood count, liver enzymes, urea, creatinine, albumin, CRP and ESR levels in patients with Covid-19. METHODS: We conducted a cross-sectional study on 118 patients with Covid-19 who were hospitalized from 2020/2/19 to 2020/4/3 in ICU. Serum levels of electrolytes, liver enzymes, blood factors, urea, creatinine, CRP and ESR, as well as anthropometric parameters and serum vitamin D concentration, were measured. RESULTS: A total of 118 patients (80 male and 38 female) were enrolled in the study (65.05±15.75 years). Only 5.08% of patients had no risk factors and 55.9% had ≥ 2 risk factors. Diabetes (44.1%) and obesity (23.7%) were more common among patients. Laboratory findings showed that 80.50% of patients had hyponatremia, but other electrolytes including K, Mg, Ca and P were normal in the majority of participants as well as CBC, Cr, Urea, Alb, ALT and ALKP. The AST concentration increased in most patients (66.94%). All patients had high levels of inflammatory factors such as CRP and ESR. The mean of 25-hydroxy-vitamin D levels in participants (25.95 ± 14.56 ng/mL) was lower than its levels in the general population. However, it was not statistically significant (P= 0.88). A significant negative correlation was found between vitamin D and ALT (P= 0.02, -0.21) as well as vitamin D and CRP (P= 0.05, -0.17). CONCLUSION: Due to the regulatory role of vitamin D in the immune system and low levels of vitamin D in Covid-19 infected patients, the evaluation of vitamin D levels and prescribed supplements, if necessary, is suggested.