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Volume 29, Number 1—January 2023
CME ACTIVITY - Synopsis

Multicenter Case–Control Study of COVID-19–Associated Mucormycosis Outbreak, India

Valliappan Muthu, Ritesh Agarwal1Comments to Author , Shivaprakash Mandya Rudramurthy, Deepak Thangaraju, Manoj Radhakishan Shevkani, Atul K. Patel, Prakash Srinivas Shastri, Ashwini Tayade, Sudhir Bhandari, Vishwanath Gella, Jayanthi Savio, Surabhi Madan, Vinay Kumar Hallur, Venkata Nagarjuna Maturu, Arjun Srinivasan, Nandini Sethuraman, Raminder Pal Singh Sibia, Sanjay Pujari, Ravindra Mehta, Tanu Singhal, Puneet Saxena, Varsha Gupta, Vasant Nagvekar, Parikshit Prayag, Dharmesh Patel, Immaculata Xess, Pratik Savaj, Naresh Panda, Gayathri Devi Rajagopal, Riya Sandeep Parwani, Kamlesh Patel, Anuradha Deshmukh, Aruna Vyas, Srinivas Kishore Sistla, Priyadarshini A Padaki, Dharshni Ramar, Saurav Sarkar, Bharani Rachagulla, Pattabhiraman Vallandaramam, Krishna Prabha Premachandran, Sunil Pawar, Piyush Gugale, Pradeep Hosamani, Sunil Narayan Dutt, Satish Nair, Hariprasad Kalpakkam, Sanjiv Badhwar, Kiran Kumar Kompella, Nidhi Singla, Milind Navlakhe, Amrita Prayag, Gagandeep Singh, Poorvesh Dhakecha, and Arunaloke Chakrabarti1
Author affiliations: Postgraduate Institute of Medical Education and Research, Chandigarh, India (V. Muthu, R. Agarwal, S.M. Rudramurthy, N. Panda, A. Chakrabarti); Kovai Medical Center and Hospital, Coimbatore, India (D. Thangaraju, G.D. Rajagopal); Avron Hospitals, Ahmedabad, India (M.R. Shevkani, R.S. Parwani); Sterling Hospital, Ahmedabad (A.K. Patel, K. Patel); Sir Gangaram Hospital, New Delhi, India (P.S. Shastri); Kingsway Hospital, Nagpur, India (A. Tayade, A. Deshmukh); Sawai Man Singh Medical College, Jaipur, India (S. Bhandari, A. Vyas); Asian Institute of Gastroenterology, Hyderabad, India (V. Gella, S.K. Sistla); St. John’s Medical College and Hospital, Bengaluru, India (J. Savio, P.A. Padaki); Care Institute of Medical Sciences, Ahmedabad (S. Madan, D. Ramar); All India Institute of Medical Science Bhubaneswar, Odisha, India (V.K. Hallur, S. Sarkar); Yashoda Hospitals, Hyderabad (V.N. Maturu, B. Rachagulla); Royal Care Hospital, Coimbatore (A. Srinivasan, P. Vallandaramam); Apollo Hospitals, Chennai, India (N. Sethuraman, K.P. Premachandran); Government Medical College, Patiala, India (R.P.S. Sibia, S. Pawar); Poona Hospital and Research Centre, Pune, India (S. Pujari, P. Gugale); Apollo Hospitals, Bengaluru (R. Mehta, H. Kalpakkam, P. Hosamani, S.N. Dutt, S. Nair); Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India (T. Singhal, S. Badhwar); Army Hospital (Research and Referral), New Delhi (P. Saxena, K.K. Kompella); Government Medical College, Chandigarh (V. Gupta, N. Singla); Global Hospital, Mumbai (V. Nagvekar, M. Navlakhe); Deenanath Mangeshkar Hospital, Pune (P. Prayag, A. Prayag); City Clinic and Bhailal Amin General Hospital, Vadodara, India (D. Patel); All India Institute of Medical Sciences, New Delhi (I. Xess, G. Singh); Institute of Infectious Disease and Critical Care Hospital, Surat, India (P. Savaj, P. Dhakecha)

Main Article

Table 3

Diagnosis, treatment practices, and survival in patients with CAM, India, January–June 2021*

Parameter No. observed/total no. (%)
Site of mucormycosis†
Rhino-orbito-cerebral
Sinus 1,526/1,733 (88.1)
Orbit 789/1,733 (45.5)
Palate 373/1,733 (21.5)
Jaw 315/1,733 (18.2)
Brain 261/1,733 (15.1)
Blackening of skin over face 102/1,733 (5.9)
Cavernous sinus 44/1,733 (2.5)
Skull base 65/1,733 (3.8)
Pulmonary† 122/1,733 (7.0)
Cutaneous or soft tissue 5/1,733 (0.3)
Gastrointestinal 2/1,733 (0.1)
Renal†
 2/1,733 (0.1)
Diagnosis of mucormycosis
Microscopy alone 352/1,733 (20.3)
Culture growth of Mucorales alone 61/1,733 (3.5)
Histopathology alone 177/1,733 (10.2)
>1 evidence (smear, culture, or histopathology) of mucormycosis
 1,143/1,733 (66.0)
Treatment practices
Intended therapy could not be administered 321/1,526 (21.0)
Missed doses due to drug non-availability
 248/1,457 (17.0)
Primary therapy
Any formulation of amphotericin B‡
 1,634/1,733 (94.3)
Primary combination therapy§
Any combination 699/1,733 (41.6)
Amphotericin B and posaconazole 541/699 (77.4)
Amphotericin B and isavuconazole 121/699 (17.3)
Amphotericin B and isavuconazole or posaconazole
 37/699 (5.3)
Surgery
Combined medical and surgical treatment
 1,449/1,773 (83.6)
Survival
Death by 6 weeks 442/1,546 (28.6)
Death by 12 weeks 473/1,471 (32.2)

*CAM, COVID-19–associated mucormycosis †Total number does not sum to 1,733 since patients might have had involvement at >1 site. There were 18 cases of disseminated mucormycosis (17 had pulmonary in addition to rhino-orbital, while 1 person had rhino-orbito-cerebral and renal mucormycosis). ‡Of the 1,634 persons receiving amphotericin B, liposomal amphotericin B alone was used in 1,210 (74.1%) patients, amphotericin B deoxycholate in 143 (8.7%) patients, amphotericin B lipid emulsion in 21 (1.3%) patients, >1 formulation in 236 (14.4%) patients, and the information was not clear in 24 (1.5%) patients. §Primary therapy with a combination of amphotericin and isavuconazole or posaconazole within the first 14 days was used in 699/1,733 (41.6%) patients.

Main Article

1These senior authors contributed equally to this article.

Page created: November 10, 2022
Page updated: December 19, 2022
Page reviewed: December 19, 2022
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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