Emerging Infectious Diseases (Jan 2023)
Multicenter Case–Control Study of COVID-19–Associated Mucormycosis Outbreak, India
- Valliappan Muthu,
- Ritesh Agarwal,
- Shivaprakash Mandya Rudramurthy,
- Deepak Thangaraju,
- Manoj Radhakishan Shevkani,
- Atul K. Patel,
- Prakash Srinivas Shastri,
- Ashwini Tayade,
- Sudhir Bhandari,
- Vishwanath Gella,
- Jayanthi Savio,
- Surabhi Madan,
- Vinay Kumar Hallur,
- Venkata Nagarjuna Maturu,
- Arjun Srinivasan,
- Nandini Sethuraman,
- Raminder Pal Singh Sibia,
- Sanjay Pujari,
- Ravindra Mehta,
- Tanu Singhal,
- Puneet Saxena,
- Varsha Gupta,
- Vasant Nagvekar,
- Parikshit Prayag,
- Dharmesh Patel,
- Immaculata Xess,
- Pratik Savaj,
- Naresh Panda,
- Gayathri Devi Rajagopal,
- Riya Sandeep Parwani,
- Kamlesh Patel,
- Anuradha Deshmukh,
- Aruna Vyas,
- Srinivas Kishore Sistla,
- Priyadarshini A Padaki,
- Dharshni Ramar,
- Saurav Sarkar,
- Bharani Rachagulla,
- Pattabhiraman Vallandaramam,
- Krishna Prabha Premachandran,
- Sunil Pawar,
- Piyush Gugale,
- Pradeep Hosamani,
- Sunil Narayan Dutt,
- Satish Nair,
- Hariprasad Kalpakkam,
- Sanjiv Badhwar,
- Kiran Kumar Kompella,
- Nidhi Singla,
- Milind Navlakhe,
- Amrita Prayag,
- Gagandeep Singh,
- Poorvesh Dhakecha,
- Arunaloke Chakrabarti
Affiliations
- Valliappan Muthu
- Ritesh Agarwal
- Shivaprakash Mandya Rudramurthy
- Deepak Thangaraju
- Manoj Radhakishan Shevkani
- Atul K. Patel
- Prakash Srinivas Shastri
- Ashwini Tayade
- Sudhir Bhandari
- Vishwanath Gella
- Jayanthi Savio
- Surabhi Madan
- Vinay Kumar Hallur
- Venkata Nagarjuna Maturu
- Arjun Srinivasan
- Nandini Sethuraman
- Raminder Pal Singh Sibia
- Sanjay Pujari
- Ravindra Mehta
- Tanu Singhal
- Puneet Saxena
- Varsha Gupta
- Vasant Nagvekar
- Parikshit Prayag
- Dharmesh Patel
- Immaculata Xess
- Pratik Savaj
- Naresh Panda
- Gayathri Devi Rajagopal
- Riya Sandeep Parwani
- Kamlesh Patel
- Anuradha Deshmukh
- Aruna Vyas
- Srinivas Kishore Sistla
- Priyadarshini A Padaki
- Dharshni Ramar
- Saurav Sarkar
- Bharani Rachagulla
- Pattabhiraman Vallandaramam
- Krishna Prabha Premachandran
- Sunil Pawar
- Piyush Gugale
- Pradeep Hosamani
- Sunil Narayan Dutt
- Satish Nair
- Hariprasad Kalpakkam
- Sanjiv Badhwar
- Kiran Kumar Kompella
- Nidhi Singla
- Milind Navlakhe
- Amrita Prayag
- Gagandeep Singh
- Poorvesh Dhakecha
- Arunaloke Chakrabarti
- DOI
- https://doi.org/10.3201/eid2901.220926
- Journal volume & issue
-
Vol. 29,
no. 1
pp. 8 – 19
Abstract
We performed a case–control study across 25 hospitals in India for the period of January–June 2021 to evaluate the reasons for an COVID-19–associated mucormycosis (CAM) outbreak. We investigated whether COVID-19 treatment practices (glucocorticoids, zinc, tocilizumab, and others) were associated with CAM. We included 1,733 cases of CAM and 3,911 age-matched COVID-19 controls. We found cumulative glucocorticoid dose (odds ratio [OR] 1.006, 95% CI 1.004–1.007) and zinc supplementation (OR 2.76, 95% CI 2.24–3.40), along with elevated C-reactive protein (OR 1.004, 95% CI 1.002–1.006), host factors (renal transplantation [OR 7.58, 95% CI 3.31–17.40], diabetes mellitus [OR 6.72, 95% CI 5.45–8.28], diabetic ketoacidosis during COVID-19 [OR 4.41, 95% CI 2.03–9.60]), and rural residence (OR 2.88, 95% CI 2.12–3.79), significantly associated with CAM. Mortality rate at 12 weeks was 32.2% (473/1,471). We emphasize the judicious use of COVID-19 therapies and optimal glycemic control to prevent CAM.
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