Endocrine Abstracts

Background: Mucormycosis is a serious but rare angio-invasive fungal infection in high-risk patients with diabetes, organ transplantation, neutropenia, and hemochromatosis. The COVID-19 pandemic has been associated with increased incidence of mucormycosis and the incidence has risen more rapidly during the second wave of pandemic in India. The clinical profiles and risk factors for severity and mortality are not very clear among patients with COVID-19 infected with mucormycosis.

Methods: Data was collected from patients hospitalized to PSG Hospitals and Research Centre, Coimbatore, Tamilnadu, India, with mucormycosis infection, during the period April 2021 to August 2021. Patients were managed surgically and medically with amphotericin B (conventional/ liposomal) for 3 weeks, followed by oral antifungal therapy for 3 weeks. We aimed to analyse the clinical profile and the risk factors for severity and mortality among these patients.

Results: 104 patients with COVID-19–associated rhino-orbito-cerebral mucormycosis (CAM) with a mean age (SD) of 53.7 (11.8) years were included in the analysis. 88 (84.6%) were men. All were type 2 diabetics (11.6% newly diagnosed). 80.8% of them had HbA1C level > 6.4% proving the risk of mucormycosis in uncontrolled diabetes (P<0.001). Endoscopic sinus surgery (ESS) with debridement was performed in 51.92% of patients. ESS with debridement, along with orbital compression was done in 21% of patients. Of the 104 patients with CAM, 16.35% died, 35.5% underwent maxillectomy, 1.92% evisceration, whereas 7.6% underwent exenteration. 81.7% had intravenous amphotericin B and 18.3% had retro-orbital amphotericin B. On multivariate analysis, intravenous amphotericin B administration (Estimate: 1.48; P = .029) and HbA1C levels (Estimate: 4.24; P=0.039) showed significant association with disease outcome.

Conclusion: Increased morbidity and mortality from mucormycosis are associated with uncontrolled diabetes mellitus and systemic steroid use. Precautions necessary to manage patients with mucormycosis in COVID-19 are control of diabetes and judicious use of steroids.