Table.
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.