Table.
Summary of clinical characteristics, treatment, and outcome of 80 cases of patients with COVID-19-associated mucormycosis
| COVID-19-associated mucormycosis (n=80)* | Rhino-orbital cerebral disease (n=59) | Pulmonary disease†(n=20) | |
|---|---|---|---|
| Median age (range), years | 55 (10–86) | 54 (10–79) | 57 (22–86) |
| Male-to-female-patient ratio | 62:18 (78%:23%) | 43:16 (73%:27%) | 18:2 (90%:10%) |
| Country of case origin | India (42 [53%]), USA (8 [10%]), Pakistan (5 [6%]), France (4 [5%]), Mexico (4 [5%]), Iran (4 [5%]), Russia (2 [3%]), Austria (1 [1%]), Bangladesh (1 [1%]), Brazil (1 [1%]), Chile (1 [1%]), Czech Republic (1 [1%]), Germany (1 [1%]), Italy (1 [1%]), Kuwait (1 [1%]), Lebanon (1 [1%]), Turkey (1 [1%]), UK (1 [1%]) | India (41 [69%]), USA (4 [7%]), Pakistan (1 [2%]), France (2 [3%]), Mexico (3 [5%]), Iran (4 [7%]), Russia (2 [3%]), Bangladesh (1 [2%]), Turkey (1 [2%]) | India (1 [5%]), USA (4 [20%]), Pakistan (4 [20%]), France (2 [10%]), Mexico (1 [5%]), Austria (1 [5%]), Chile (1 [5%]), Czech Republic (1 [5%]), Germany (1 [5%]), Italy (1 [5%]), Kuwait (1 [5%]), Lebanon (1 [5%]), UK (1 [5%]) |
| Underlying conditions | Diabetes (66 [83%], 55 [83%] of which had uncontrolled diabetes‡), haematological malignancy (5 [6%]§), lymphopenia (2 [3%]), hypertension (1 [1%]), chronic kidney disease (1 [1%]), severe obesity (1[1%]), no known risk factor (4 [5%]) | Diabetes (55 [93%], 48 [87%] of which had uncontrolled diabetes), haematological malignancy (1 [2%]), hypertension (1 [2%]), no known risk factor (2 [3%]) | Diabetes (11 [55%], 7 [64%] of which had uncontrolled diabetes), haematological malignancy (4 [20%]), lymphopenia (1 [5%]), chronic kidney disease (1 [5%]), severe obesity (1 [5%]), no known risk factor (2 [10%]) |
| Comorbidities¶ | Hypertension (14 [18%]), kidney disease (6 [8%]), obesity (3 [4%]), cardiac disease (5 [6%]), asthma (2 [3%]), hyperlipidaemia (2 [3%]) | Hypertension (7 [12%]), kidney disease (4 [7%]), obesity (1 [2%]), cardiac disease (2 [3%]), asthma (2 [3%]), hyperlipidaemia (2 [3%]) | Hypertension (6 [30%]), kidney disease (2 [10%]), cardiac disease (3 [15%]), hypothyroidism (1 [5%]), pancreatitis (1 [5%]), obesity (1 [5%]) |
| COVID-19 diagnosis | On admission (58 [68%]), previous (10 [13%]), during admission (1 [1%]), unknown (14 [18%]) | On admission (37 [63%]), previous (9 [15%]), unknown (13 [22%]) | On admission (17 [85%]), previous (1 [5%]), during admission (1 [5%]), unknown (1 [5%]) |
| COVID-19 severity | Severe or critical (36 [45%]), mild or moderate (36 [45%]), asymptomatic (2 [3%]), unknown (6 [8%]) | Severe or critical (19 [32%]), mild or moderate (33 [56%]), asymptomatic (2 [3%]), unknown (5 [8%]) | Severe or critical (16 [80%]), mild or moderate (4 [20%]) |
| Intensive care unit admission | Yes (38 [48%]), no (34 [43%]), unknown (8 [10%]) | Yes (19 [32%]), no (33 [56%]), unknown (7 [12%]) | Yes (18 [90%]), no (1 [5%]), unknown (1 [5%]) |
| Corticosteroids administered | Yes (63 [79%])‖, no (14 [18%]), unknown (3 [4%]) | Yes (47 [80%]), no (10 [17%]), unknown (2 [3%]) | Yes (15 [75%]), no (4 [20%]), unknown (1 [5%]) |
| Causative Mucorales spp | Rhizopus spp (16 [20%]), Mucor spp (6 [8%])**, R arrhizus (11 [14%]), R microsporus (7 [9%]), Lichtheimia spp (1 [1%]), Rhizomucor pusillus (1 [1%]), not specified (39 [49%]) | Rhizopus spp (10 [17%]), Mucor spp (6 [10%])**, R arrhizus (8 [14%]), Lichtheimia spp (1 [2%]), R microsporus (1 [2%]), not specified (34 [58%]) | Rhizopus spp (6 [30%]), R microsporus (6 [30%]), R arrhizus (3 [15%]), R pusillus (1 [5%]), not specified (4 [20%]) |
| Antifungal therapy | Liposomal amphotericin B (54 [68%]), conventional amphotericin B (9 [11%]), unknown amphotericin B formulation (7 [9%]), amphotericin lipid complex (2 [3%]), voriconazole (5 [6%]) isavuconazole (5 [6%]), posaconazole (6 [8%]), caspofungin (2 [3%]), micafungin (1 [1%]), antifungal combination (ie, drugs simultaneously; 14 [18%]), none (2 [3%]), unknown (1 [1%]) | Liposomal amphotericin B (44 [75%]), conventional amphotericin B (5 [8%]), unknown amphotericin B formulation (6 [10%]), amphotericin lipid complex (2 [3%]), voriconazole (2 [3%]), isavuconazole (2 [3%]), posaconazole (6 [10%]), caspofungin (1 [2%]), antifungal combination (ie, drugs simultaneously; 10 [17%]), none (1 [2%]), unknown (1 [2%]) | Liposomal amphotericin B (10 [50%]), conventional amphotericin B (4 [20%]), unknown amphotericin B formulation (1 [5%]), voriconazole (3 [15%]), isavuconazole (3 [15%]), caspofungin (1 [5%]), micafungin (1 [5%]), antifungal combination (ie, drugs simultaneously; 4 [20%]), none (1 [5%]) |
| Surgical intervention | Yes (45 [56%]), no (29 [36%]), deferred or unknown (6 [8%]) | Yes (43 [72%]), no (12 [20%]), deferred or unknown (4 [7%]) | Yes (2 [10%]), no (16 [80%]), deferred or unknown (2 [10%]) |
| Therapeutic strategy | Systemic antifungals plus surgery (44 [55%]), systemic antifungals only (32 [40%]), surgery only (1 [1%]), none (2 [3%]), unknown (1 [1%]) | Systemic antifungals plus surgery (42 [71%]), systemic antifungals only (15 [25%]), surgery only (1 [2%]), unknown (1 [2%]) | Systemic antifungals plus surgery (2 [10%]), systemic antifungals only (17 [85%]), none (1 [5%]) |
| Fungal coinfections | Aspergillosis (9 [11%]), none (71 [89%]) | Aspergillosis (3 [5%]), none (56 [95%]) | Aspergillosis (6 [30%]), none (14 [70%]) |
| Outcome | Survived (37 [46%]), died (39 [49%]), unknown (4 [5%]) | Survived (33 [56%]), died (22 [37%]), unknown (4 [7%]) | Survived (4 [20%]), died (16 [80%]) |
| Life-changing morbidities in survivors | Loss of vision (19 [24%]) | Loss of vision (19 [32%]) | .. |
Data are n (%) unless otherwise specified; n is the number of patients and the percentage is the proportion of patients out of the total indicated at the top of the column.
*
Includes 59 patients with rhino-orbital cerebral disease, 20 patients with pulmonary disease (three of whom had disseminated pulmonary disease), and one patient with gastrointestinal disease.
†
Includes 17 patients with pulmonary disease only and three patients with pulmonary disease and disseminated disease.
‡
Well-controlled diabetes was reported in eight (12%) of 66 patients; the diabetes status of patients was unknown in three of 66 patients.
§
Two patients had lymphoma, two patients had acute myeloid leukaemia, and one patient had acute lymphoblastic leukaemia.
¶
Numbers are super-additive.
‖
Details available from 40 patients: 28 patients were given dexamethasone 6 mg for 10 days, and 12 were given methylprednisolone (40–120 mg for 5–28 days after hospital admission).
**
Rhizopus and Mucor spp was identified in one patient.