Epidemiology, clinical presentation and management of COVID‐19 associated mucormycosis: A single centre experience from Pune, Western India
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Abstract
Background
The second COVID‐19 wave in India has been associated with an unprecedented increase in cases of COVID‐19 associated mucormycosis (CAM), mainly Rhino‐orbito‐cerebral mucormycosis (ROCM).
Methods
This retrospective cohort study was conducted at Noble hospital and Research Centre (NHRC), Pune, India, between 1 April, 2020, and 1 August, 2021, to identify CAM patients and assess their management outcomes. The primary endpoint was incidence of all‐cause mortality due to CAM.
Results
59 patients were diagnosed with CAM. Median duration from the first positive COVID‐19 RT PCR test to diagnosis of CAM was 17 (IQR: 12,22) days. 90% patients were diabetic with 89% having uncontrolled sugar level (HbA1c >7%). All patients were prescribed steroids during treatment for COVID‐19. 56% patients were prescribed steroids for non‐hypoxemic, mild COVID‐19 (irrational steroid therapy), while in 9%, steroids were prescribed in inappropriately high dose. Patients were treated with a combination of surgical debridement (94%), intravenous liposomal Amphotericin B (91%) and concomitant oral Posaconazole (95.4%). 74.6% patients were discharged after clinical and radiologic recovery while 25.4% died. On relative risk analysis, COVID‐19 CT severity index ≥18 ( p = .017), presence of orbital symptoms ( p = .002), presence of diabetic ketoacidosis ( p = .011) and cerebral involvement ( p = .0004) were associated with increased risk of death.
Conclusions
CAM is a rapidly progressive, angio‐invasive, opportunistic fungal infection, which is fatal if left untreated. Combination of surgical debridement and antifungal therapy leads to clinical and radiologic improvement in majority of cases.
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SciScore for 10.1101/2021.09.15.21263622: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics not detected. Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
Software and Algorithms Sentences Resources All data was analyzed by SPSS version 12.0. SPSSsuggested: (SPSS, RRID:SCR_002865)Results from OddPub: Thank you for sharing your data.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Limitations: Our study has several limitations. First, this is not a randomized controlled trial, and therefore unmeasured confounding cannot be ruled out. Second, as for all retrospective studies, some individuals diagnosed with Mucormycosis may be unreported leading …
SciScore for 10.1101/2021.09.15.21263622: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics not detected. Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
Software and Algorithms Sentences Resources All data was analyzed by SPSS version 12.0. SPSSsuggested: (SPSS, RRID:SCR_002865)Results from OddPub: Thank you for sharing your data.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Limitations: Our study has several limitations. First, this is not a randomized controlled trial, and therefore unmeasured confounding cannot be ruled out. Second, as for all retrospective studies, some individuals diagnosed with Mucormycosis may be unreported leading to measurement bias and underestimation of mortality due to CAM. Third, we collected data from a single centre in India unlike other multicenter cohort studies [7, 52,54,55,57]. Fourth, an overwhelmed health care system, inadequate workforce and lack of exhaustive reporting due to surge of cases during second COVID wave could be responsible for underestimation of co-morbidities, presenting symptoms and complications amongst patients in our cohort. Fifth, inflammatory markers like Ferritin, CRP and D-dimer were not available for all patients in the cohort. Sixth, we did not look for environmental factors causing healthcare-associated mucormycosis like contaminated ventilation systems, air conditioners, and ongoing construction in our hospital. We did not estimate the burden of Mucormycetes spores in our hospital environment. We also didn’t investigate the link between risk factors like use of industrial oxygen during the COVID pandemic, contaminated nebulizer fluids or inline humidifier tubing used in ventilator circuits and contaminated oxygen delivery systems with increased incidence of CAM in our cohort [10]. Seventh, other unexplored factors, including genetic predisposition were not identified. Despite these...
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.
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