Akshaya Ramaswami1, Ankit Kumar Sahu1, Akshay Kumar2, Soorya Suresh1, Archana Nair1, Devansh Gupta1, Rahul Chouhan1, Rachana Bhat1, Roshan Mathew1, Jameel A3, Praveen Aggarwal4, Jamshed Nayer2, Meera Ekka2, Alok Thakar5, Gagandeep Singh6, Immaculata Xess7, Naveet Wig8. 1. Resident, All India Institute of Medical Sciences, Department of Emergency Medicine, Ansari Nagar, New Delhi, India. 2. Assistant Professor, All India Institute of Medical Sciences, Department of Emergency Medicine, Ansari Nagar, New Delhi, India. 3. Nursing Officer, All India Institute of Medical Sciences, Department of Emergency Medicine, Ansari Nagar, New Delhi, India. 4. Professor and Head, All India Institute of Medical Sciences, Department of Emergency Medicine, Ansari Nagar, New Delhi, India. 5. Professor and Head, All India Institute of Medical Sciences, Department of Otorhinolaryngology, Ansari Nagar, New Delhi, India. 6. Associate Professor, All India Institute of Medical Sciences, Department of Microbiology, Ansari Nagar, New Delhi, India. 7. Professor, All India Institute of Medical Sciences, Department of Microbiology, Ansari Nagar, New Delhi, India. 8. Professor and Head, All India Institute of Medical Sciences, Department of Medicine, Ansari Nagar, New Delhi, India.
Abstract
BACKGROUND: Mucormycosis is a deadly opportunistic fungal infection and a large surge in COVID-19 associated mucormycosis (CAM) is occurring in India. AIM: Our aim was to delineate the clinico-epidemiological profile and identify risk factors of CAM patients presenting to the Emergency Department (ED). DESIGN: This was a retrospective, single center, observational study. METHODS: We included patients who presented with clinical features or diagnosed mucormycosis and who were previously treated for COVID-19 in last three months of presentation (recent COVID-19) or currently being treated for COVID-19 (active COVID-19). Information regarding clinical features of CAM, possible risk factors, examination findings, diagnostic workup including imaging and treatment details were collected. RESULTS: Seventy CAM patients (median age: 44.5 years, 60% males) with active (75.7%) or recent COVID-19 (24.3%) who presented to the ED in between 6th May 2021 to 1st June 2021, were included. A median duration of 20 days (IQR: 13.5 - 25) was present between the onset of COVID-19 symptoms and the onset of CAM symptoms. 93% patients had at least one risk factor. Most common risk factors were diabetes mellitus (70%) and steroid use for COVID-19 disease (70%). After clinical, microbiological, and radiological workup, final diagnosis of rhino-orbital CAM was made in most patients (68.6%). Systemic antifungals were started in the ED and urgent surgical debridement was planned. CONCLUSION: COVID-19 infection along with its medical management have increased patient susceptibility to mucormycosis.
BACKGROUND: Mucormycosis is a deadly opportunistic fungal infection and a large surge in COVID-19 associated mucormycosis (CAM) is occurring in India. AIM: Our aim was to delineate the clinico-epidemiological profile and identify risk factors of CAM patients presenting to the Emergency Department (ED). DESIGN: This was a retrospective, single center, observational study. METHODS: We included patients who presented with clinical features or diagnosed mucormycosis and who were previously treated for COVID-19 in last three months of presentation (recent COVID-19) or currently being treated for COVID-19 (active COVID-19). Information regarding clinical features of CAM, possible risk factors, examination findings, diagnostic workup including imaging and treatment details were collected. RESULTS: Seventy CAM patients (median age: 44.5 years, 60% males) with active (75.7%) or recent COVID-19 (24.3%) who presented to the ED in between 6th May 2021 to 1st June 2021, were included. A median duration of 20 days (IQR: 13.5 - 25) was present between the onset of COVID-19 symptoms and the onset of CAM symptoms. 93% patients had at least one risk factor. Most common risk factors were diabetes mellitus (70%) and steroid use for COVID-19 disease (70%). After clinical, microbiological, and radiological workup, final diagnosis of rhino-orbital CAM was made in most patients (68.6%). Systemic antifungals were started in the ED and urgent surgical debridement was planned. CONCLUSION:COVID-19infection along with its medical management have increased patient susceptibility to mucormycosis.