Two major risk factors seen in Covid-linked mucormycosis

KOCHI: High prevalence of diabetes and administration of corticosteroids for treatment of coronavirus infection increases the risk of Covid-19-associated mucormycosis (CAM), with mortality in one-fifth of the patients.

Mucormycosis is a fungal infection caused by fungi belonging to Mucorales. It is highly aggressive with a tendency for contiguous spread. This infection occurs by inhalation of spores, which are ubiquitous. The fungus can then disseminate to various organs rapidly. Prognosis is poor if the diagnosis and management are delayed. Maximum cases of CAM have been reported from India. This is possibly explained by the high prevalence of diabetes in the country, which is second only to China.

However, the death rate reported from India 37% was less than the globally reported 62% probably due to the predominance of mucormycosis which may pose fewer hurdles in medical and surgical management.

A multicentric observational study was conducted in 23 centres across India to study the clinical profile of CAM. Clinical details, including the treatment and severity of Covid-19, associated morbidities, as well as diagnosis, treatment and prognosis of CAM in 115 patients were studied. Out of 115 patients from 23 centres across India who participated in the study, 31 patients required intensive care and were admitted to the ICU for a week or more. One of the most notable findings was that 71% had pre-existing diabetes and 14% had newly detected diabetes. In other words, a total of 85% of patients had diabetes.

Most of the studies, including this study, show that 100% of patients who developed CAM were treated with corticosteroids for Covid-19. Based on the study, the authors said that an aggressive normalization of glucose should be practised, which may be difficult but possible, as the most important factor regarding CAM is uncontrolled glycemia that could decrease immunity to several infections. They suggested that the blood glucose level should be maintained in the range of 70-180 mg/dl.

Dr Jothydev Kesavadev, an investigator of the study from Kerala, said that remote glucose monitoring with the help of bluetooth connected glucose meters or with the help of continuous glucose monitoring (CGM) devices are some of the proven and efficient digital solutions which will eliminate excess exposure of the medical professionals to the virus but at the same time help ensure more frequent glucose monitoring and aggressive control of glucose.