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Novel Risk Factors for Coronavirus Disease-Associated Mucormycosis (CAM): A Case Control Study During the Outbreak in India
Background: The epidemiology of the Coronavirus-disease associated mucormycosis (CAM) syndemic is poorly elucidated. In this study, we aimed to analyse the risk factors for CAM, in addition to those established for mucormycosis prior to COVID-19 pandemic.
Methods: We performed a case-control study comparing patients diagnosed with CAM with those who had recovered from COVID-19 without developing mucormycosis. Information on comorbidities, glycaemic control, and practices related to COVID-19 prevention and management was recorded.
Findings: One hundred fifty-two cases of CAM and 200 controls diagnosed with COVID-19 during April–May 2021 were included. In the CAM group, symptoms of mucormycosis began a mean 18·9 ± 9·1 days after the symptom onset of COVID-19. All, but one patient, carried either of the conventional risk factors: diabetes and steroid use. On multivariate regression analysis, risk factors associated with increased odds of CAM included presence of diabetes (aOR 3·5, 95%CI 1·1–11), poor glycaemic control (p<0.05 for blood glucose levels >200 mg/dL), use of systemic steroids (aOR 7·7,95% CI 2·4–24·7), prolonged use of cloth and surgical masks (vs N95 masks, aOR 17·5, 95% CI 4·6-66·7), and repeated nasopharyngeal swab testing (aOR 1·6,95% CI 1·2–2·2).
Interpretation: CAM is strongly associated with diabetes, poor glycaemic control, and systemic steroid use. Novel risk factors identified in our study include prolonged use of cloth and surgical masks vis-a-vis N95 masks, and repeated nasopharyngeal swab testing. Oxygen therapy and need for hospitalization for COVID-19 did not affect the risk of CAM.
Funding Information: This was an investigator-initiated non-funded study.
Declaration of Interests: The authors declare that they have no competing interests.
Ethics Approval Statement: The study was approved by the Institute Ethics Committee, AIIMS, Delhi, India. [IECPG-353/28.05.21].
Arora, Umang and Priyadarshi, Megha and Katiyar, Varidh and Soneja, Manish and Garg, Prerna and Gupta, Ishan and Bharadiya, Vishwesh and Berry, Parul and Ghosh, Tamoghna and Patel, Lajja and Sarda, Radhika and Garg, Shreya and Agarwal, Shubham and Arora, Veronica and Ramprasad, Aishwarya and Kumar, Amit and Kumar, Rohit and Kodan, Parul and Nischal, Neeraj and Singh, Gagandeep and Jorwal, Pankaj and Kumar, Arvind and Baitha, Upendra and Ray, Animesh and Sethi, Prayas and Xess, Immaculata and Vikram, Naval Kishore and Sinha, Sanjeev and Biswas, Ashutosh and Thakar, Alok and Bhatnagar, Sushma and Trikha, Anjan and Wig, Naveet, Novel Risk Factors for Coronavirus Disease-Associated Mucormycosis (CAM): A Case Control Study During the Outbreak in India. Available at SSRN: https://ssrn.com/abstract=3893463 or http://dx.doi.org/10.2139/ssrn.3893463
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