COVID-19 associated mucormycosis (CAM) in Kashan, Iran: clinical presentations, risk factors, management, and outcomes

Abstract

Background

This study aimed to estimate the disease burden and describe the clinical presentation, risk factors, and outcome of CAM in a single centre in Iran.

Methods

A case of mucormycosis was defined as one that had clinical and radiological features consistent with mucormycosis along with demonstration of the fungus in tissue via KOH mount/culture/histopathological and molecular examination.

Results

We report 30 cases of COVID-19 associated mucormycosis (CAM). The results of this study showed the affected age group in the range of 40–79 years (median = 65.5; IQR = 5) with women (16/30, 53%) affected more than men (14/30, 47%). Among the fungi recovered, Rhizopus oryzae had the highest frequency (79%). Out of the 30 patients, 28 (93%) patients were diabetic with 24 (80%) patients having other co-morbidities. Headache followed by retro-orbital pain, proptosis/ptosis and rapid diminution of vision was a common sequence of symptoms reported by the majority of cases. Use of mechanical ventilation (58% vs. 6%, p = 0.003), O₂ required (92% vs. 50%, p = 0.024), and development of renal dysfunction during hospital stay (17% vs. 0%, p = 0.041) was significantly higher in non-survivors than survivors. Temperature (C°), PR (pulse rate), mean levels of serum creatinine, BUN, troponin, and neutrophils were significantly higher in non-survivors (p < 0.05). Besides, Albumin and PO₂ were also significantly higher in survivors than non-survivors.

Conclusion

Despite medical and surgical treatment, the mortality rate among CAM patients is still high. Thus, concerted efforts of revamping surveillance, diagnosis and management, along with public awareness and patient education, are the requisites for managing COVID-19 and mucormycosis.

Keywords:

• Mucormycosis
• SARS-CoV-2
• COVID-19
• fungal infection

Acknowledgement

We acknowledge the financial support of the Tehran University of Medical Sciences to this study. Sincere gratitude to all professors and students of parasitology and mycology at the School of Public Health in Tehran University of Medical Sciences, Kashan Shahid Beheshti Hospital.

Ethical statement

The Ethical Clearance Committee of the Iran University of Medical Sciences approved the study under Reference no. IR.TUMS.SPH.REC.1399.329.

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Consent to publication

All co-authors agreed to the submission of the current form of the manuscript.

Authors’ contributions

Study concept and design: S.J.H., M.E. Collecting samples and laboratory work: M.E., A.H.M., S.H.A., H.M., M.M.H., A.H.A., M.G., and H.H.J. Analysis and interpretation of data: S.J.H., A.H.M., A.H.A., O.R. Drafting of the manuscript: O.R., and M.I.G. Critical revision of the manuscript for important intellectual content: O.R., M.I.G., H.M. Statistical analysis: O.R., S.A. All authors reviewed the manuscript.

Disclosure statement

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

Data availability statement

All data are presented in the main manuscript.

Additional information

Funding

This work was supported by the Research Council of Tehran University of Medical Science with the project ethics number IR.TUMS.SPH.REC.1399.329.