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Profile of Mucormycosis Cases from a Network of Hospitals in North India amidst COVID-19 Pandemic

Sandeep Budhiraja, Mona Aggarwal, Monica Mahajan, Abhaya Indrayan, Vinita Jha, Ambrish Mithal, Sanjay Sachdeva, Ritu Raj Barua, Sumit Mrig, Anurag Jain, Ravinder Gera, Rahul Aggarwal, Suven Kalra, WVPS Ramalingam, Anupal Deka, Arjun Das, D Jijina, Ajit Mansingh, Anuj Singhal, Rajashekhar Reddi, Puneet Aggarwal, Mukesh Kumar, JD Mukherjee, Vivek Nangia, Ajay Lall, Omender Singh, Arun Dewan, Ajay Jain, Gita G Shrivastava, Mala Bhattacharjee, Meena Nihalani, Manoj Kumar4, Meenakshi Jain, Mukesh Mehra, Vijay Arora, Viresh Prashant Mehta, Dilip Bhalla4, Amit Batra, Rajesh Gupta, Vivek Kumar, Sanjeev Dua, Praveen Pandey, Y P Singh, Mohit Mathur, Ashok Singh, Sanjeev Arora, Ajay Kumar Gupta, Pankajnand Choudhary, Manoj Singh, Namita Kaul, Sitla Prasad Pathak, Sharad Joshi, Manish Gupta, Rajesh Mishra, Alok Joshi, Manoj Aggarwal, Rajiv Gupta, Vandana Boobna, Yogesh Kumar Chhabra, Inder Mohan Chugh, Sandeep Garg, Vikas Mittal, Neha Sood, Anil Kumar, Rajesh Kumar Pande, V P Singh, Iram Khan, Nitin Garg, Puneet Tyagi, Shantanu Belwal, Anup Kumar Roy, Deepak Bhasin, Sachin Pandove, Ravikant Bahl, Prateek Soni

Incidence of mucormycosis suddenly surged in India after the second wave of COVID-19. This is a crippling disease and needs to be studied in detail to understand the disease, its course, and the outcomes. Between 1st March and 15th July 2021, our network of hospitals in North India received a total of 155 cases of COVID-associated mucormycosis cases as all of them reported affliction by COVID-19 earlier or concurrent. Their records were retrieved from the Electronic Health Records system of the hospitals and their demographics, clinical features, treatments, and outcomes were studied. More than 80% (125 cases) had proven disease and the remaining 30 were categorized as ‘possible’ mucormycosis as per the EORTC criteria. More than two-thirds (69.0%) of the cases were males and the mean age was 53 years for either sex. Nearly two-thirds (64.5%) had symptoms of nose and jaws and 42.6% had eye involvement. Some had multiple symptoms, as many as 78.7% had diabetes and 91.6% gave history of use of steroids during COVID-19 treatment. The primary surgery was functional endoscopic sinus surgery (FESS) (83.9%). Overall mortality was 16.8%, which is one-and-a-half times the mortality in hospitalized COVID-19 patients in the corresponding population. Occurrence of mucormycosis was associated with diabetes and use of steroids, but mortality was not associated with either of them. Cases undergoing surgery and on antifungal had steeply lower mortality (11.9% vs. 50.0%, P<0.001) than those who were exclusively on antifungal drugs. Treatment by different drugs did not make much of a difference in mortality.