Table 1.
Comparison of COVID-19-associated mucormycosis (CAM) reported from India and the rest of the world
| India (n = 233) | Rest of the world (n = 42) | P value | |
|---|---|---|---|
| Age in years (n = 87) | 56.1 (17–88) | 52.8 (14–86) | 0.14 |
| Male sex | 187/233 (80.3) | 32/42 (76.2) | 0.34 |
| COVID-19 details | |||
| Hypoxemia | 93/158 (58.9) | 37/41 (90.2) | 0.0001 |
| Mechanical ventilation | 68/209 (32.5) | 20/40 (50) | 0.03 |
| Glucocorticoid therapy | 184/229 (80.3) | 27/38 (71.1) | 0.19 |
| Cumulative glucocorticoid dosea | 156.1 (0–1343) | 59.4 (12–121) | 0.05 |
| Indication for corticosteroidsb | 0.001 | ||
| Appropriate | 67/233 (28.8) | 10/19 (52.6) | |
| Inappropriate dose or duration | 52/233 (22.3) | 7/19 (36.8) | |
| Not indicated | 52/233 (22.3) | 2/19 (10.5) | |
| No information or not used | 62/233 (26.6) | 23/42 (54.8) | |
| Tocilizumab | 6/233 (2.6) | 5/42 (11.9) | 0.015 |
| Underlying disease | 0.001 | ||
| COVID-19 only | 64/233 (28.8) | 11/42 (26.2) | |
| Diabetes mellitus | 154/233 (66.1) | 23/42 (54.8) | |
| Hematologic malignancy | 2/233 (0.9) | 4/42 (9.5) | |
| SOT | 5/233 (2.1) | 4/42 (9.5) | |
| Othersc | 8/233 (3.4) | 0 | |
| Diabetic ketoacidosis | 29/211 (13.7) | 2/25 (8) | 0.55 |
| Time to mucormycosis from COVID-19, days | 19.9 (-14 to 101) | 17.2 (-4 to 100) | 0.38 |
| Late CAM (> 7 days after COVID-19) | 185/232 (79.7) | 27/42 (64.3) | 0.028 |
| Site of CAM | 0.001 | ||
| ROM | 137/233 (58.8) | 20/42 (47.6) | |
| ROCM | 69/233 (29.6) | 7/42 (16.7) | |
| Pulmonary | 17/233 (7.3) | 9/42 (21.4) | |
| Othersd | 10/233 (4.3) | 6/42 (14.3) | |
| Organism identified (n = 41) | 0.0001 | ||
| Rhizopus arrhizus | 13/24 (54.2) | 4/17 (23.5) | |
| Rhizopus spp. | 6/24 (25) | 5/17 (29.4) | |
| Rhizopus microsporus | 1/24 (4.2) | 6/17 (35.3) | |
| Otherse | 4/24 (16.6) | 2/17 (11.8) | |
| Treatment | |||
| Amphotericin | 0.89 | ||
| No amphotericin | 26/233 (11.2) | 5/42 (11.9) | |
| Any formulation | 207/233 (88.8) | 37/42 (88.1) | |
| Posaconazole | 80/204 (39.2) | 12/42 (28.6) | 0.19 |
| Isavuconazole | 19/198 (9.6) | 7/41 (17.1) | 0.16 |
| Surgery | 0.31 | ||
| None | 65/233 (27.9) | 15/42 (35.7) | |
| Complete or partial surgery | 168/233 (72.1) | 27/42 (64.3) | |
| Mortality | 85/233 (36.5) | 26/42 (61.9) | 0.002 |
All the values are presented as mean (range) or numbers/total number of patients [n/N] and percentages
CAM COVID-19-associated mucormycosis, COVID coronavirus disease, L-AMB liposomal amphotericin B, ROM rhino-orbital mucormycosis, ROCM rhino-orbito-cerebral mucormycosis, SOT solid organ transplantation
aDose as dexamethasone equivalent
bIndication was classified as (1) not indicated if glucocorticoids were used in the absence of hypoxemia, (2) appropriate if the dose and duration did not exceed the existing evidence (dexamethasone 6 mg OD [or equivalent] for a duration up to ten days), (3) inappropriate, if the dose or duration exceeded the existing evidence
cOther risk factors included trauma, dental procedure, cirrhosis, and immunosuppressive therapies
dOther sites included disseminated, gastrointestinal, cutaneous, and other site
eOthers included Lichtheimia (n = 4), and Mucor spp. (n = 2)