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Covid-19-associated rhino-orbito-cerebral mucormycosis (CAROM) in Delhi: Demographics and risk factors in a single-centre consecutive cohort of 200 inpatients.
Singh, Anup; Sikka, Kapil; Goel, Gaurav; Kanodia, Anupam; Chandran, Aswin; Konkimalla, Abhilash; Panda, Smriti; Garg, Rohit K; Xess, Immaculata; Tandon, Nikhil; Thakar, Alok.
Affiliation
  • Singh A; Department of Otorhinolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
  • Sikka K; Department of Otorhinolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
  • Goel G; Department of Otorhinolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
  • Kanodia A; Department of Otorhinolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
  • Chandran A; Department of Otorhinolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
  • Konkimalla A; Department of Otorhinolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
  • Panda S; Department of Otorhinolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
  • Garg RK; Department of Medicine and Infectious Diseases, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
  • Xess I; Department of Microbiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
  • Tandon N; Department of Endocrinology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
  • Thakar A; Department of Otorhinolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
Natl Med J India ; 35(3): 132-137, 2022.
Article in En | MEDLINE | ID: mdl-36461870
Background There was a dramatic rise in the incidence of rhino-orbito-cerebral mucormycosis associated with the 2021 Covid-19 wave in India. We aim to document the demographic characteristics and risk factors of a consecutive cohort of inpatients with Covid-19-associated rhino-orbito-cerebral mucormycosis (CAROM) during the surge of April-June 2021. Methods We included all patients of CAROM treated at our tertiary referral facility from 1 April to 14 June 2021. We prospectively gathered details with regard to Covid-19 illness and treatment, CAROM presentation, comorbid conditions and risk factors. Results Our prospective cohort consisted of 200 consecutive patients, of which 146 (73%) patients tested positive on the Covid-19 RT-PCR test at presentation. CAROM occurred concurrent with the Covid-19 infection in 86%, and delayed CAROM after seeming recovery from Covid-19 was seen in 14%. Covid-19 was classified as mild, moderate and severe in 54%, 33% and 13%. The surge of CAROM followed the population peak of Covid-19 infections by about 3 weeks. Advanced disease at presentation was frequent with ocular involvement in 56.6% (111/196) and central nervous system involvement in 20% (40/199). One or more comorbid conditions were identified in 191/200 (95.5%) patients. The dominant associations were with diabetes (189/200; 94.5%) and uncontrolled hyper-glycaemia (122/133; 91.7%), recent steroid use (114/ 200; 57%), which was often considered as inappropriate in dosage or duration, lymphopenia (142/176; 80.7%), and increased ferritin levels (140/160; 87.5%). No evidence supported the role of previous oxygen therapy or previous nasal swab testing as risk factors for CAROM. Conclusion The inpatient volumes of CAROM were noted to parallel the Covid-19 incidence curve by about 3 weeks. Covid-19 infection may directly predispose to CAROM by way of lymphopenia and increased ferritin levels. Uncontrolled hyperglycaemia is identified as a near-invariable association. Recent steroid use is noted as very frequent and was often received in excess of treatment advisories.
Subject(s)

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: COVID-19 / Lymphopenia / Mucormycosis Type of study: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limits: Humans Language: En Journal: Natl Med J India Journal subject: MEDICINA Year: 2022 Document type: Article Affiliation country: India Country of publication: India

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: COVID-19 / Lymphopenia / Mucormycosis Type of study: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limits: Humans Language: En Journal: Natl Med J India Journal subject: MEDICINA Year: 2022 Document type: Article Affiliation country: India Country of publication: India