P174 Prevalence and outcomes of patients with COVID - associated mucormycosis (CAM): A case series
Authors: Chakraborty Sangeeta , Shastri Prakash 
Published: September 2022

Abstract

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM

Background and objective
Coronavirus disease-19 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus-2 (SARS-COV-2) virus has been associated with increased secondary bacterial and fungal infections. A few centers from India have reported a high number of cases of COVID-associated mucormycosis (CAM). Depending on the anatomical site of infection, mucromycosis is classified as rhino-orbito-cerebral, pulmonary, gastrointestinal, cutaneous, renal, and disseminated mucromycosis. Several risk factors such as uncontrolled diabetes mellitus, hematologic malignancies, renal disease, organ transplant, and corticosteroid therapy administered for COVID-19 are implicated in CAM. In this study, we report a case series of CAM, presenting its prevalence, clinical features, risk factors, etiological agents, site of infection, and outcomes in a single center.

Methods
A retrospective data analysis of all proven mucormycosis cases among COVID-19 infected patients from September 1, 2020 to December 31, 2020, was carried out after approval from the institutional ethics committee. All proven cases of mucormycosis (either by culture from sterile site or histopathology), along with compatible clinical and radiological findings, in patients with positive real-time-polymerase chain reaction (RT-PCR) for SARS-CoV-2 within 2 months of the diagnosis of mucormycosis were included in the study. All patients received treatment for COVID-19 and mucormycosis as per the institutional protocol. Data was collected in a predefined case-record form developed for the study which included demographic characteristics, risk factors, days to the diagnosis of mucormycosis after COVID-19, site of involvement by mucormycosis along with microscopy, culture and histopathology, treatment details and outcome at 6 and 12 weeks.

Results
During the study period, a total of 19 patients were diagnosed with CAM. The major risk factors of the patients were type 2 diabetes mellitus (DM) (n = 15, 78.9%) and steroid therapy (n = 18, 94.7%), The other co-morbidities included hypertension (n = 7, 38.8), chronic kidney disease (CKD) (n = 4, 22.2%) and chronic liver disease (n = 1, 5.2%). Rhino orbital mucromycosis (ROM) was the most common form (n = 9, 47.3%). The prevalence of CAM (as calculated by the total number of cases of CAM divided by the number of COVID-19 cases treated) was 5.47/1000 COVID patients during the study period. Majority (15, 73.6%) of the patients were successfully treated and discharged whereas three patients succumbed to infection and one left against medical advice. The mortality in this cohort (n = 4) was 21.05% as compared with 13.9% among all COVID patients (n = 9) admitted during the same time period in 2020.

Conclusion
Though sample size is small, the findings in our study suggest that the fatality from COVID-associated mucormycosis is high, though the risk factors remain the same. The incidence of mucormycosis was twice that in non-pandemic period. Early diagnosis is crucial as despite aggressive surgical medical therapy, mortality continues to be high.