Iranian patients co-infected with COVID-19 and mucormycosis: the most common predisposing factor, clinical outcomes, laboratory markers and diagnosis, and drug therapies

Abstract

Background

The newly emerged pandemic of coronavirus disease-2019 (COVID-19) is the world's main health challenge because infected patients become vulnerable to a variety of opportunistic diseases.

Objective

This study aimed to assess clinical outcomes, diagnosis, utilized drug therapies, and ongoing COVID-19 practices in Iranian cases co-infected with COVID-19 and mucormycosis.

Participants and methods

A case-series analysis was conducted in the presence of 10 patients with COVID-19 and mucormycosis co-infection (two men and eight women; mean age of 48.8 years) from March to October 2020. Demographic variables, signs/symptoms, and comorbidities of all patients were recorded. COVID-19 was confirmed with reverse transcription polymerase chain reaction (RT-PCR) nasopharyngeal swab tests and high-resolution computed tomography (HR-CT)_ scans.

Results

All patients had a positive RT-PCR for SARS-CoV-2. Eight patients had a history of diabetes, while three of them exhibited a hypertension history. Remarkable laboratory findings were elevated fasting blood sugar in 6 cases and anaemia in four patients. A rhino-orbital-cerebral of mucormycosis in all patients was detected based on HR-CT scans and otorhinolaryngological or ophthalmological examinations. Neurological disorders including facial, trigeminal, optic, and oculomotor nerve involvement resulted in paraesthesia, pain, ptosis, no light perception, blurred vision, and papilledema in five cases. Maxillary and ethmoid sinuses were the most common sites of involvement.

Conclusion

Vulnerable COVID-19 patients with comorbidities, any facial involvements, or treated by excessive doses of glucocorticoids and antibiotics should undergo precise examinations during the appearance of early signs and hospitalization to diagnose and treat mucormycosis using the standard care and antifungal treatments.

Keywords:

• COVID-19
• nCoV2019
• rhinocerebral mucormycosis
• coinfection
• antifungal
• antibiotic

Acknowledgements

We acknowledge the guidance and advice from ‘Clinical Research Development Unit of Baqiyatallah Hospital.’ The authors received no financial support for the research, authorship, and/or publication of this article.

Ethical approval

This research was conducted according to the protocol approved by the Ethics Committee of Baqiyatallah University of Medical Sciences (Tehran, Iran) with an ethical code of IR.BMSU.REC.1399.536. All methods were performed following the relevant guidelines and regulations. Before conducting this study, verbal and written informed consent was obtained from all patients. Written informed consent was obtained from the participants for the publication of this study.

Author contributions

HM, ES, and EN designed the study. HM and LK collected and interpreted the data and prepared the figures and tables. ES, LK, and SYM drafted the manuscript. NJJ, MI, and BE conceived the research plan and supervised and coordinated all the work. The final version of this manuscript has been read and approved by all authors and it is not under consideration for publication elsewhere.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The dataset generated and analysed during the study is available from the corresponding author on reasonable request.