Mucormycosis and Covid-19 : Risk Factors, Clinical Presentation and Outcome in a Tertiary Care Centre in North India.

ABSTRACT

A wide range of opportunistic infections have been described in patients with Coronavirus disease 2019 (COVID-19). Aspergillus and Candida have been reported as the main fungal pathogens for co-infection in these patients. Mucormycosis including Rhino-Orbital-Cerebral Mucormycosis (ROCM) has been increasingly described in patients with COVID-19 disease but the risk factors and outcome of such patients are not well described. MATERIAL: This prospective observational study was conducted at a tertiary centre in North India of 50 patients with radiologically and microbiologically proven Mucormycosis. OBSERVATION The included subjects were evaluated for the risk factors, the clinical presentation, and outcomes. Frequency(t=50) Percentage 1 Age Below 40 10 20 40 and above 40 80 2 Sex F 21 42 M 29 58 3 Covid 19 history positive 39 78 negative 4 8 nr 7 14 4 HTN history Present 21 42 absent 29 58 5 Diabetes history present 42 84 absent 8 16 6 Duration of DM <1 month 8 16 >1 month 26 52 NR 16 32 7 Vaccination Status Vaccinated 2 4 Not vaccinated 48 96 8 HbA1c <6.5 7 14 6.5 to 7 7 14 >7 27 54 9 History of hospital/ home oxygen Present 17 34 absent 33 66 10 SpO2 during admission <90 1 2 90to95 8 16 >95 37 74 No record available 4 8 11 pH at admission <7.35 4 8 7.35 to 7.45 16 32 >7.45 7 14 Data not available 23 46 12 TLC <4400 1 2 4400 to 10900 27 54 >11000 16 32 Data Not available 6 12 Steroid Use in Hospital Stay prednisolone 2 4 Dexamethasone 23 46 13 Hydrocortisone 1 2 Methylprednisolone 1 2 Unavailable 4 8 Not received 19 38 14 Outcome Discharged 41 82 Expired 6 12 Absconded 3 6. CONCLUSION: Out of the 50 patients under study, 78% had Covid-19 disease. The primary risk factor of Mucor in patients of Covid-19 was Diabetes Mellitus (84%) with known diabetics (52%) having uncontrolled hyperglycemia (54%) and those who required oxygen support (home/ hospital) (32%). Mucor was more common in males (58%) of age 40 years and above (80%). About 96% of these patients were not vaccinated against Covid-19, and only 42% had a history of Hypertension. Dexamethasone was used in 46% of the patients admitted and 82% were discharged with satisfactory recovery.