Risk factors for Coronavirus disease-associated mucormycosis
Umang Arora, Megha Priyadarshi, Varidh Katiyar, Manish Soneja, Prerna Garg, Ishan Gupta, Vishwesh Bharadiya, Parul Berry, Tamoghna Ghosh, Lajjaben Patel, Radhika Sarda, Shreya Garg, Shubham Agarwal, Veronica Arora, Aishwarya Ramprasad, Amit Kumar, Rohit Kumar Garg, Parul Kodan, Neeraj Nischal, Gagandeep Singh, Pankaj Jorwal, Arvind Kumar, Upendra Baitha, Ved Prakash Meena, Animesh Ray, Prayas Sethi, Immaculata Xess, Naval Vikram, Sanjeev Sinha, Ashutosh Biswas, Alok Thakar, Sushma Bhatnagar, Anjan Trikha, Naveet Wig
Journal of Infection, doi:10.1016/j.jinf.2021.12.039
Background: The epidemiology of the Coronavirus-disease associated mucormycosis (CAM) syndemic is poorly elucidated. We aimed to identify risk factors that may explain the burden of cases and help develop preventive strategies. Methods: We performed a case-control study comparing cases diagnosed with CAM and taking controls as recovered COVID 19 patients who did not develop mucormycosis. Information on comorbidities, glycemic control, and practices related to COVID-19 prevention and treatment was recorded. Multivariate regression analysis was used to identify independent predictors. Results: A total of 352 patients (152 cases and 200 controls) diagnosed with COVID-19 during April-May 2021 were included. In the CAM group, symptoms of mucormycosis began a mean of 18.9 (SD 9.1) days after onset of COVID-19, and predominantly rhino-sinus and orbital involvement was present. All, but one, CAM cases had conventional risk factors of diabetes and steroid use. On multivariable regression, increased odds of CAM were associated with the presence of diabetes (adjusted OR 3.5, 95% CI 1.1-11), use of systemic steroids (aOR 7.7, 95% CI 2.4-24.7), prolonged use of cloth and surgical masks (vs. no mask, aOR 6.9, 95%CI 1.5-33.1), and repeated nasopharyngeal swab testing during the COVID-19 illness (aOR 1.6, 95% CI 1.2-2.2). Zinc therapy was found to be protective (aOR 0.05, 95%CI 0.01-0.19). Notably, the requirement of oxygen supplementation or hospitalization did not affect the risk of CAM. Conclusion: Judicious use of steroids and stringent glycemic control are vital to preventing mucormycosis. Use of clean masks, preference for N95 masks if available, and minimizing swab testing after the diagnosis of COVID-19 may further reduce the incidence of CAM.
IRB approval The study was approved by the Institute Ethics Committee, AI-IMS, Delhi, India. [IECPG-353/28.05.21]
Authors' contributions All listed authors meet the ICMJE criteria. We attest that all authors contributed significantly to the creation of this manuscript, each having fulfilled the criteria as established by the ICMJE.
Declaration of Competing Interest The authors declare that they have no competing interests.
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