Clinical, laboratory and radiological assessment of patients with COVID-19 associated mucormycosis (CAM) along with their management profile: an observational study

Abstract

OBJECTIVE: The Corona Virus Disease 19 (COVID-19) has become the most significant health problem worldwide. The surge of secondary infection (particularly fungal infections) in COVID-19 cases has been encountered in the form of Mucormycosis. Diabetes, indiscriminate use of corticosteroids, severity of COVID-19 infection are the few notable risk factors. The aim of this study was to determine the risk factors associated with Mucormycosis in COVID-19 patients, to assess the laboratory and radiological changes in COVID-19 associated Mucormycosis (CAM) patients and to evaluate the management profile in CAM patients. MATERIALS AND METHODS: This is a prospective observational study carried out on 105 COVID-19 patients admitted to COVID-19/Mucormycosis isolation ward for a duration of 6 months. Patient demographic data, clinical history, laboratory investigations, radiological findings and management profile were assessed. Various risk factors were assessed against the onset of mucormycosis (early/late). RESULTS: This study was conducted on 105 patients with history of COVID-19 infections now presented with features of mucormycosis. Mean age was 54.29 ±10.21 years (36-78 years). Male to female ratio-10.67:1. Only 12 active COVID-19 cases. Mean time interval between the onset of mucormycosis and COVID-19 symptoms was 27.6±5.9 days with early onset disease (n=57,54.3%) and late onset disease (n=48,45.7%). Mean lag time between onset of symptoms and diagnosis was 9.24±2.23 days. Mean duration of steroid administration was 15.46±4.67 days with short duration (n=60,57.1%) and long duration (n=45,42.9%). Most common symptom and sign in our study group was facial pain (n=102,97.1%), sinus tenderness and conjunctival congestion with 81 cases (77.1%) each, respectively. The most common comorbidity was Diabetes Mellitus (n=84,80%). Rhino-orbital was the most common system involved (n=57,54.3%) and nasal involvement in all cases. Of the various parameters, the severity of COVID-19 infection (based on CTSS score) was associated with early onset mucormycosis (p-value-0.0001). The mortality rate was 42.86% (n=45). CONCLUSIONS: In a patient with COVID-19 Associated Mucormycosis, risk factors such as diabetes mellitus and indiscriminate use of corticosteroids play a prominent role. Severity of the COVID-19 infection (assessed by CTSS) was found to be associated with early onset disease.

Keywords

• covid-19
• mucormycosis
• cam
• fungus
• steroid.