Risk factors for Coronavirus disease-associated mucormycosis
Retrospective 152 COVID-associated mucormycosis cases and 200 controls, showing lower risk of COVID-associated mucormycosis with zinc treatment.
risk of progression, 95.0% lower, OR 0.05, p < 0.001, case control OR.
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Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
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Arora et al., 31 Mar 2022, retrospective, India, peer-reviewed, 34 authors.
Abstract: Journal of Infection 84 (2022) 383–390
Contents lists available at ScienceDirect
Journal of Infection
journal homepage: www.elsevier.com/locate/jinf
Risk factors for Coronavirus disease-associated mucormycosis
Umang Arora a, Megha Priyadarshi a, Varidh Katiyar b, Manish Soneja a, Prerna Garg a,
Ishan Gupta a, Vishwesh Bharadiya a, Parul Berry a, Tamoghna Ghosh a, Lajjaben Patel a,
Radhika Sarda a, Shreya Garg c, Shubham Agarwal a, Veronica Arora d,
Aishwarya Ramprasad a, Amit Kumar a, Rohit Kumar Garg a, Parul Kodan a, Neeraj Nischal a,
Gagandeep Singh e, Pankaj Jorwal a, Arvind Kumar a, Upendra Baitha a, Ved Prakash Meena a,
Animesh Ray a, Prayas Sethi a, Immaculata Xess e, Naval Vikram a, Sanjeev Sinha a,
Ashutosh Biswas a, Alok Thakar c, Sushma Bhatnagar f, Anjan Trikha g, Naveet Wig a,∗
a
Department of Medicine, AIIMS, Delhi, India
Department of Neurosurgery, AIIMS, Delhi, India
c
Department of Otolaryngology & Head-Neck Surgery, AIIMS, Delhi, India
d
Department of Medical Genetics, Sir Ganga Ram Hospital, Delhi, India
e
Department of Microbiology, AIIMS, Delhi, India
f
Department of Onco-anaesthesia and Palliative Medicine, AIIMS, Delhi, India
g
Department of Anaesthesiology, Pain Medicine and Critical Care, AIIMS, Delhi, India
b
a r t i c l e
i n f o
Article history:
Accepted 27 December 2021
Available online 30 December 2021
Keywords:
Mucormycosis
COVID-19
Risk factors
Case control
s u m m a r y
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.
© 2021 The British Infection Association. Published by Elsevier Ltd. All rights reserved.
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