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Novel Risk Factors for Coronavirus Disease-Associated Mucormycosis (CAM): A Case Control Study During the Outbreak in India

22 Pages Posted: 27 Jul 2021

See all articles by Umang Arora

Umang Arora

All India Institute of Medical Sciences (AIIMS) - Department of Medicine

Megha Priyadarshi

All India Institute of Medical Sciences (AIIMS) - Department of Medicine

Varidh Katiyar

All India Institute of Medical Sciences (AIIMS) - Department of Neurosurgery

Manish Soneja

All India Institute of Medical Sciences (AIIMS) - Department of Medicine

Prerna Garg

All India Institute of Medical Sciences (AIIMS) - Department of Medicine

Ishan Gupta

All India Institute of Medical Sciences (AIIMS) - Department of Medicine

Vishwesh Bharadiya

All India Institute of Medical Sciences (AIIMS) - Department of Medicine

Parul Berry

All India Institute of Medical Sciences (AIIMS) - Department of Medicine

Tamoghna Ghosh

All India Institute of Medical Sciences (AIIMS) - Department of Medicine

Lajja Patel

All India Institute of Medical Sciences (AIIMS) - Department of Medicine

Radhika Sarda

All India Institute of Medical Sciences (AIIMS) - Department of Medicine

Shreya Garg

All India Institute of Medical Sciences (AIIMS) - Department of Otolaryngology & Head-Neck Surgery

Shubham Agarwal

All India Institute of Medical Sciences (AIIMS) - Department of Medicine

Veronica Arora

Sir Ganga Ram Hospital - Department of Medical Genetics

Aishwarya Ramprasad

All India Institute of Medical Sciences (AIIMS) - Department of Medicine

Amit Kumar

All India Institute of Medical Sciences (AIIMS) - Department of Medicine

Rohit Kumar

All India Institute of Medical Sciences (AIIMS) - Department of Medicine

Parul Kodan

All India Institute of Medical Sciences (AIIMS) - Department of Medicine

Neeraj Nischal

All India Institute of Medical Sciences (AIIMS) - Department of Medicine

Gagandeep Singh

All India Institute of Medical Sciences (AIIMS) - Department of Microbiology

Pankaj Jorwal

All India Institute of Medical Sciences (AIIMS) - Department of Medicine

Arvind Kumar

All India Institute of Medical Sciences (AIIMS) - Department of Medicine

Upendra Baitha

All India Institute of Medical Sciences (AIIMS) - Department of Medicine

Animesh Ray

All India Institute of Medical Sciences (AIIMS) - Department of Medicine

Prayas Sethi

All India Institute of Medical Sciences (AIIMS) - Department of Medicine

Immaculata Xess

All India Institute of Medical Sciences (AIIMS) - Department of Microbiology

Naval Kishore Vikram

All India Institute of Medical Sciences (AIIMS) - Department of Medicine

Sanjeev Sinha

All India Institute of Medical Sciences (AIIMS) - Department of Medicine

Ashutosh Biswas

All India Institute of Medical Sciences (AIIMS) - Department of Medicine

Alok Thakar

All India Institute of Medical Sciences (AIIMS) - Department of Otolaryngology & Head-Neck Surgery

Sushma Bhatnagar

All India Institute of Medical Sciences (AIIMS) - Department of Onco-Anesthesia & Palliative Medicine

Anjan Trikha

All India Institute of Medical Sciences (AIIMS) - Department of Anaesthesia, Pain Medicine & Critical Care Medicine

Naveet Wig

All India Institute of Medical Sciences (AIIMS) - Department of Medicine

More...

Abstract

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].

Suggested Citation

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

Umang Arora

All India Institute of Medical Sciences (AIIMS) - Department of Medicine ( email )

New Delhi
India

Megha Priyadarshi

All India Institute of Medical Sciences (AIIMS) - Department of Medicine ( email )

New Delhi
India

Varidh Katiyar

All India Institute of Medical Sciences (AIIMS) - Department of Neurosurgery ( email )

Aurobindo Marg
Ansari Nagar East
New Delhi, New Delhi 110029
India

Manish Soneja

All India Institute of Medical Sciences (AIIMS) - Department of Medicine ( email )

New Delhi
India
9013074717 (Phone)

Prerna Garg

All India Institute of Medical Sciences (AIIMS) - Department of Medicine ( email )

New Delhi
India

Ishan Gupta

All India Institute of Medical Sciences (AIIMS) - Department of Medicine ( email )

New Delhi
India

Vishwesh Bharadiya

All India Institute of Medical Sciences (AIIMS) - Department of Medicine ( email )

New Delhi
India

Parul Berry

All India Institute of Medical Sciences (AIIMS) - Department of Medicine ( email )

New Delhi
India

Tamoghna Ghosh

All India Institute of Medical Sciences (AIIMS) - Department of Medicine ( email )

New Delhi
India

Lajja Patel

All India Institute of Medical Sciences (AIIMS) - Department of Medicine ( email )

New Delhi
India

Radhika Sarda

All India Institute of Medical Sciences (AIIMS) - Department of Medicine

New Delhi
India

Shreya Garg

All India Institute of Medical Sciences (AIIMS) - Department of Otolaryngology & Head-Neck Surgery ( email )

Aurobindo Marg
Ansari Nagar East
New Delhi, New Delhi 110029
India

Shubham Agarwal

All India Institute of Medical Sciences (AIIMS) - Department of Medicine ( email )

New Delhi
India

Veronica Arora

Sir Ganga Ram Hospital - Department of Medical Genetics

New Delhi
India

Aishwarya Ramprasad

All India Institute of Medical Sciences (AIIMS) - Department of Medicine ( email )

New Delhi
India

Amit Kumar

All India Institute of Medical Sciences (AIIMS) - Department of Medicine ( email )

New Delhi
India

Rohit Kumar

All India Institute of Medical Sciences (AIIMS) - Department of Medicine ( email )

New Delhi
India

Parul Kodan

All India Institute of Medical Sciences (AIIMS) - Department of Medicine ( email )

New Delhi
India

Neeraj Nischal

All India Institute of Medical Sciences (AIIMS) - Department of Medicine ( email )

New Delhi
India

Gagandeep Singh

All India Institute of Medical Sciences (AIIMS) - Department of Microbiology ( email )

New Delhi
India

Pankaj Jorwal

All India Institute of Medical Sciences (AIIMS) - Department of Medicine ( email )

New Delhi
India

Arvind Kumar

All India Institute of Medical Sciences (AIIMS) - Department of Medicine ( email )

New Delhi
India

Upendra Baitha

All India Institute of Medical Sciences (AIIMS) - Department of Medicine ( email )

New Delhi
India

Animesh Ray

All India Institute of Medical Sciences (AIIMS) - Department of Medicine ( email )

New Delhi
India

Prayas Sethi

All India Institute of Medical Sciences (AIIMS) - Department of Medicine ( email )

New Delhi
India

Immaculata Xess

All India Institute of Medical Sciences (AIIMS) - Department of Microbiology ( email )

New Delhi
India

Naval Kishore Vikram

All India Institute of Medical Sciences (AIIMS) - Department of Medicine ( email )

New Delhi
India

Sanjeev Sinha

All India Institute of Medical Sciences (AIIMS) - Department of Medicine ( email )

New Delhi
India

Ashutosh Biswas

All India Institute of Medical Sciences (AIIMS) - Department of Medicine ( email )

New Delhi
India

Alok Thakar

All India Institute of Medical Sciences (AIIMS) - Department of Otolaryngology & Head-Neck Surgery ( email )

Aurobindo Marg
Ansari Nagar East
New Delhi, New Delhi 110029
India

Sushma Bhatnagar

All India Institute of Medical Sciences (AIIMS) - Department of Onco-Anesthesia & Palliative Medicine ( email )

New Delhi
India

Anjan Trikha

All India Institute of Medical Sciences (AIIMS) - Department of Anaesthesia, Pain Medicine & Critical Care Medicine ( email )

New Delhi
India

Naveet Wig (Contact Author)

All India Institute of Medical Sciences (AIIMS) - Department of Medicine ( email )

New Delhi
India