Coronavirus disease (COVID-19) causes an immunosuppressed state and increases risk of secondary infections like mucormycosis. We evaluated clinical features, predisposing factors, diagnosis and outcomes for mucormycosis among patients with COVID-19 infection.
This prospective, observational, multi-centre study included 47 consecutive patients with mucormycosis, diagnosed during their course of Covid-19 illness, between January 3 to March 27, 2021. Data regarding demography, underlying medical conditions, Covid-19 illness and treatment were collected. Clinical presentations of mucormycosis, imaging and biochemical characteristics and outcome were recorded.
Of the 2567 COVID-19 patients admitted to 3 tertiary centers, 47 (1.8%) were diagnosed with mucormycosis. Mean age was 55±12.8years and majority suffered from diabetes mellitus (n=36, 76.6%). Most were not COVID-19 vaccinated (n=31, 66.0%) and majority (n=43, 91.5%) had developed moderate-to-severe pneumonia, while 20 (42.6%) required invasive ventilation. All patients had received corticosteroids and broad-spectrum antibiotics while most (n=37, 78.7%) received at least one anti-viral medication. Mean time elapsed from COVID-19 diagnosis to mucormycosis was 12.1±4.6days. Eleven (23.4%) subjects succumbed to their disease, mostly (n=8, 72.7%) within 7-days of diagnosis. Among the patients who died, 10 (90.9%) had pre-existing diabetes mellitus, only 2 (18.2%) had received just one vaccine dose and all developed moderate-to-severe pneumonia, requiring oxygen supplementation and mechanical ventilation.
Mucormycosis can occur among COVID-19 patients, especially with poor glycemic control, widespread and injudicious use of corticosteroids and broad-spectrum antibiotics, and invasive ventilation. Owing to the high mortality, high index of suspicion is required to ensure timely diagnosis and appropriate treatment in high-risk populations.

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