Profile of Mucormycosis Cases from a Network of Hospitals in North India Amidst COVID-19 Pandemic

  1. Sandeep Budhiraja
  2. Mona Aggarwal
  3. Monica Mahajan
  4. Abhaya Indrayan
  5. Vinita Jha
  6. Ambrish Mittal
  7. Sanjay Sachdeva
  8. Sumit Mrig
  9. Anurag Jain
  10. Ravinder Gera
  11. Rahul Aggarwal
  12. Suven Kalra
  13. WVPS Ramalingam
  14. Anupal Deka
  15. Arjun Das
  16. D Jijina
  17. Ajit Mansingh
  18. Anuj Singhal
  19. Rajashekhar Reddi
  20. Puneet Aggarwal
  21. Mukesh Kumar
  22. JD Mukherjee
  23. Vivek Nangia
  24. Ajay Lall
  25. Omender Singh
  26. Arun Dewan
  27. Ajay Jain
  28. Gita G Shrivastava
  29. Mala Bhattacharjee
  30. Meena Nihalani
  31. Manoj Kumar
  32. Meenakshi Jain
  33. Mukesh Mehra
  34. Vijay Arora
  35. Viresh Prashant Mehta
  36. Dilip Bhalla
  37. Amit Batra
  38. Rajesh Gupta
  39. Vivek Kumar
  40. Sanjeev Dua
  41. Praveen Pandey
  42. Y P Singh
  43. Mohit Mathur
  44. Ashok Singh
  45. Sanjeev Arora
  46. Ajay Kumar Gupta
  47. Pankaj Nand Choudhary
  48. Manoj Singh
  49. Namita Kaul
  50. Sitla Prasad Pathak
  51. Sharad Joshi
  52. Manish Gupta
  53. Rajesh Mishra
  54. Alok Joshi
  55. Manoj Aggarwal
  56. Rajiv Gupta
  57. Vandana Boobna
  58. Yogesh Kumar Chhabra
  59. Inder Mohan Chugh
  60. Sandeep Garg
  61. Vikas Mittal
  62. Neha Sood
  63. Anil Kumar
  64. Rajesh Kumar Pande
  65. V P Singh
  66. Iram Khan
  67. Nitin Garg
  68. Puneet Tyagi
  69. Shantanu Belwal
  70. Anup Kumar Roy
  71. Deepak Bhasin
  72. Sachin Pandove
  73. Ravikant Bahl
  74. Prateek Soni

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Abstract

Incidence of mucormycosis suddenly surged in India after the second wave of COVID-19. This is a crippling disease and needs to be studied in detail to understand the disease, its course, and the outcomes.

Between 1 st March and 15 th July 2021, our network of hospitals in North India received a total of 155 cases of COVID-associated mucormycosis cases as all of them reported affliction by COVID-19 earlier or concurrent. Their records were retrieved from the Electronic Health Records system of the hospitals and their demographics, clinical features, treatments, and outcomes were studied. More than 80% (125 cases) had proven disease and the remaining 30 were categorized as ‘possible’ mucormycosis as per the EORTC criteria.

More than two-thirds (69.0%) of the cases were males and the mean age was 53 years for either sex. Nearly two-thirds (64.5%) had symptoms of nose and jaws and 42.6% had eye involvement. Some had multiple symptoms. As many as 78.7% had diabetes and 91.6% gave history of use of steroids during COVID-19 treatment. The primary surgery was functional endoscopic sinus surgery (FESS) (83.9%). Overall mortality was 16.8%, which is one-and-a-half times the mortality in hospitalized COVID-19 patients in the corresponding population. Occurrence of mucormycosis was associated with diabetes and use of steroids, but mortality was not associated with either of them. Cases undergoing surgery and on antifungal had steeply lower mortality (11.9% vs. 50.0%, P < 0.001) than those who were exclusively on antifungal drugs. Treatment by different drugs did not make much of a difference in mortality.

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  1. ScreenIT

    SciScore for 10.1101/2021.08.25.21262404: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsIRB: Ethics Committee Approval and Consent: This study was approved by the Institutional Ethics Committee, Max Super Speciality Hospital (A unit of Devki Devi Foundation), Address : Service Floor, Office of Ethics Committee, East Block, next to Conference Room, Max Super Speciality Hospital,
    Consent: All the admitted patients gave a prior consent for their anonymised data to be used for research purpose.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Antibodies
    SentencesResources
    All these cases gave history of COVID-19, diagnosed by RT-PCR for SARS-CoV-2 or by an alternative method like rapid antigen test, IgG neutralizing antibody to SARS-CoV-2 or a high-resolution CT scan of chest.
    antigen test, IgG
    suggested: None
    SARS-CoV-2
    suggested: None
    Software and Algorithms
    SentencesResources
    The patients were classified into Proven, Probable or Possible Mucormycosis as per the case definition suggested by the European Organization for Research and Treatment of Cancer (EORTC) and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (MSG) [5].
    EORTC
    suggested: (EORTC, RRID:SCR_004070)
    SPSS 21 was used for all the calculations.
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2021.08.25.21262404v1 on medRxiv