New onset hyperglycaemia and prolonged systemic corticosteroids therapy in mild COVID-19 patients are major risk factors for invasive mucormycosis – A Preliminary study

Document Type : Original Articles

Authors

1 Department of Internal Medicine, All India Institute of Medical Sciences Jodhpur, India

2 Department of Internal Medicine and Infectious Disease, All India Institute of Medical Sciences Jodhpur, India

3 Department of Internal Medicine and Infectious Disease, All India Institute of Medical Sciences Jodhpur (India)

4 Department of Otorhinolaryngology, All India Institute of Medical Sciences Jodhpur, India

5 Department of Microbiology, All India Institute of Medical Sciences Jodhpur, India

6 Department of Internal Medicine, All India Institutes of Medical Sciences Jodhpur, India

7 Department of CMFM, All India Institute of Medical Sciences Jodhpur, India

8 Department of Pulmonary Medicine, All India Institute of Medical Sciences Jodhpur, India

9 Department of Internal Medicine, All India Institute of Medical Sciences Jodhpur (India)

10 Director and CEO, All India Institute of Medical Sciences Jodhpur, India

10.18502/cmm.7.3.7254

Abstract

Background and Objectives : Rapid surge of invasive mucormycosis has surprised the Indian health care system amidst the coronavirus disease-19 (COVID-19) pandemic. Hence, there is an urgent need to find the risk factors for the sudden rise in cases of invasive mucormycosis in COVID-19. This study was aimed to find crucial risk factors for the sudden surge of invasive mucormycosis in India.
Materials and Methods: This case-control study included 77 cases of CAM and 45 age, sex and COVID-19 disease severity matched controls without mucormycosis who were confirmed with reverse transcription-polymerase chain reaction at our tertiary care centre during April-May 2021. Probable predisposing factors such as duration of diabetes mellitus, history of recent hospitalization, duration of hospital stay, mode of oxygen supplementation received, use of steroids, zinc, vitamin c and any other specific drugs were collected and compared between the two groups. Also, the laboratory parameters like glycated haemoglobin (HbA1c), highly sensitive C-reactive protein (hs-CRP) and erythrocyte sedimentation rate (ESR) were analysed to find out the significant association with CAM. Results – Diabetes mellitus (Odds ratio = 7.7, 95% CI 3.30 - 18.12; p= <0.0001) and high glycated haemoglobin level (HbA1c > 7.5 gm %) (odds ratio = 6.2, 95% CI 1.4 - 26.7; p = 0.014) were significant risk factors for development of invasive mucormycosis among the COVID-19 cases. More number of mild COVID-19 cases developed CAM compared to the moderate to severe category (59.7% vs 40.3%). Use of systemic corticosteroids (odd ratio = 5 with 95% CI 1.5 - 16.9; p=0.007) was found as a risk factor for invasive mucormycosis in mild COVID-19cases only. Use of oxygen, zinc supplementation, vitamin C supplementation and proprietary medicine did not confer a significant risk of invasive mucormycosis in cases compared to controls. Cases with invasive mucormycosis had a higher level of inflammatory markers (hs-CRP and ESR, p = <0.001 and 0.002, respectively) when compared with controls. Conclusion : Uncontrolled and new-onset DM and the use of systemic corticosteroids in mild cases were significantly associated with a higher risk of invasive mucormycosis in COVID-19 cases. There should be a strong recommendation against the use of systemic corticosteroids in mild COVID-19.

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