Thread by @RajeevJayadevan

Study on 287 “black fungus” mucormycosis cases last year (4 months from Sept to December 2020) in India, published in CDC.

See thread for main points.

-37% were not diabetic. -18% were on home treatment.
-Excess steroid use was a risk factor.

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wwwnc.cdc.gov/eid/article/27…

Among the 287 mucormycosis cases of Sept-Dec 2020, 187 (65%) were associated with COVID-19, or “CAM”.

154 out of 187 were “late CAM” or occurred >8 days after diagnosis of COVID-19.

33/187 (17.6%) patients were managed for COVID-19 at home before developing CAM.

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Among the total 187 CAM patients, only 63% had diabetes.

The % of underlying diabetes was the same as non-COVID-19 mucormycosis.

COVID-19 was the ONLY underlying disease in 61/187 (33%) CAM patients, among whom 48 (79%) received glucocorticoid treatment for COVID-19.

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13 of these 61 (previously apparently healthy except for COVID-19) cases did not receive glucocorticoid or other immunomodulatory therapies.

2.7% of the CAM patients in this study received tocilizumab.

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The median time to CAM diagnosis was 18 days.

Among 187 CAM patients, 158 (84.2%) were classified as “late” CAM (>8 days after COVID-19 onset)

Inappropriate glucocorticoid use was associated with late COVID-associated mucormycosis “late CAM”

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“Appropriate” steroid use was defined as dexamethasone-equivalent doses of 6 mg/day used for <10 days. Any excess in dose or duration was classified as “inappropriate”.

More mucormycosis cases were identified during the 2020 study period than the same period in 2019.

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The number of mucormycosis cases unrelated to COVID-19 did not differ much during both the study periods (112 cases in 2019 vs. 92 cases in 2020), indicating the increase in 2020 was chiefly attributed to CAM.

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No information is available in this retrospective analysis about home remedies, excessive steam use, nasal swabs, supplement or other medication use, antibiotics use, environmental factors or mask hygiene as potential predisposing factors.

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The site of mucormycosis involvement and the survival at 6 and 12 weeks was similar in CAM and non-CAM groups.

No increase in pulmonary cases was found in the CAM group (but there are diagnostic limitations).

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Rhizopus arrhizus, Rhizomucor pusillus, Apophysomyces variabilis, Lichtheimia corymbifera were the main species.

Diabetes was newly detected in 20% in COVID19 group, compared to 10% of non Covid mucormycosis group.

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The incidence of mucormycosis doubled, compared to the same period in 2019, this increase was directly from COVID-19 associated mucormycosis.

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Thanks @Nainamishr94 for alerting me about this paper. It answers some questions, but due to its retrospective nature, the study does not address other risk factors that might play a role in the sudden surge in India.
A case-control study is required; shall await results.

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