Risk factor profile of Mucormycosis in COVID 19 patients: A Case series

Abstract

Coronavirus disease-19 (COVID-19)-infected patients are at risk to develop severe opportunistic infections, especially fungal infections. The incidence of mucormycosis has increased in patients who are recovering from COVID-19 and now it has become an epidemic in India. In the background of the COVID-19 pandemic, we present a case series of seven patients with mucormycosis and their risk factor profile. Six of our patients had nonketotic poorly controlled glycemic status. All patients were mild or asymptomatic as far as COVID-19 clinical symptoms are concerned, but they had high inflammatory markers such as interleukin 6 (IL-6), ferritin, and D-dimer, which are commonly seen in a cytokine storm. Hyperglycemia and COVID-19 infection were consistent features in our patients. We found that COVID-19 patients with poor glycemic control and high inflammatory markers are at high risk for mucormycosis infection. However, the duration from the diagnosis of COVID-19 and the development of symptoms of mucormycosis was varied from 1 to 12 days (mean- 5.71). There was no correlation of the level of IL-6 or D-dimer with the early onset of mucormycosis. We also did not find any correlation of mucormycosis with other proposed risk factors such as oxygen therapy, steam inhalation, or prolonged steroid therapy, since four of our patients had never received steroids in any form and three had received only mild dosages of steroid. The sample size for statistical analysis was inadequate. However, a randomized clinical trial or larger observational study is needed to establish this observation.

Keywords

• covid-19
• d-dimer
• hyperglycemia
• interleukin 6
• mucormycosis
• steroids