Mucormycosis and COVID‐19: An epidemic within a pandemic in India

Selarka, Lav; Sharma, Suktara; Saini, Dinesh; Sharma, Sanjay; Batra, Amit; Waghmare, Vishal T.; Dileep, Pratibha; Patel, Sanket; Shah, Monarch; Parikh, Tejas; Darji, Prakash; Patel, Amit; Goswami, Gaurav; Shah, Anand; Shah, Sandeep; Lathiya, Harsh; Shah, Moksha; Sharma, Pranita; Chopra, Surabhi; Gupta, Ankur; Jain, Neha; Khan, Erum; Sharma, Vijay K.; Sharma, Arvind K.; Chan, Amanda C. Y.; Ong, Jonathan J. Y.

IMPORTANCE: Coronavirus disease (COVID‐19) causes an immunosuppressed state and increases risk of secondary infections like mucormycosis. We evaluated clinical features, predisposing factors, diagnosis and outcomes for mucormycosis among patients with COVID‐19 infection. METHODS: This prospective, observational, multi‐centre study included 47 consecutive patients with mucormycosis, diagnosed during their course of COVID‐19 illness, between January 3 and March 27, 2021. Data regarding demography, underlying medical conditions, COVID‐19 illness and treatment were collected. Clinical presentations of mucormycosis, imaging and biochemical characteristics and outcome were recorded. RESULTS: Of the 2567 COVID‐19 patients admitted to 3 tertiary centres, 47 (1.8%) were diagnosed with mucormycosis. Mean age was 55 ± 12.8years, and majority suffered from diabetes mellitus (n = 36, 76.6%). Most were not COVID‐19 vaccinated (n = 31, 66.0%) and majority (n = 43, 91.5%) had developed moderate‐to‐severe pneumonia, while 20 (42.6%) required invasive ventilation. All patients had received corticosteroids and broad‐spectrum antibiotics while most (n = 37, 78.7%) received at least one anti‐viral medication. Mean time elapsed from COVID‐19 diagnosis to mucormycosis was 12.1 ± 4.6days. Eleven (23.4%) subjects succumbed to their disease, mostly (n = 8, 72.7%) within 7 days of diagnosis. Among the patients who died, 10 (90.9%) had pre‐existing diabetes mellitus, only 2 (18.2%) had received just one vaccine dose and all developed moderate‐to‐severe pneumonia, requiring oxygen supplementation and mechanical ventilation. CONCLUSIONS: Mucormycosis can occur among COVID‐19 patients, especially with poor glycaemic control, widespread and injudicious use of corticosteroids and broad‐spectrum antibiotics, and invasive ventilation. Owing to the high mortality, high index of suspicion is required to ensure timely diagnosis and appropriate treatment in high‐risk populations.