COVID-19 Associated Mucormycosis (CAM) - A Case Series from a Tertiary Care Hospital in India

Research Article

Austin Med Sci. 2022; 7(1): 1064.

COVID-19 Associated Mucormycosis (CAM) - A Case Series from a Tertiary Care Hospital in India

Sharma P¹, Singh MK¹, Malhotra N¹, Sharma DK¹, Beniwal D¹, Kataria S², Arora S³, Jariwala S³, Singh P¹* and Trehan N²

¹Medanta Institute of Education and Research, Gurugram, Haryana, India

²Medanta, The Medicity, Gurugram, Haryana, India

³Albert Einstein College of Medicine, Bronx, NY, USA

*Corresponding author: Padam Singh, Chief Statistical Adviser, Medanta Institute of Education and Research Sector-38, Gurgaon-122001, Haryana, India

Received: March 24, 2022; Accepted: April 14, 2022; Published: April 21, 2022


Purpose: Coronavirus disease (COVID-19) remains a health concern with new emerging challenges as rise of opportunistic mucormycosis infections in COVID-19 patients has been found to increase morbidity and mortality. Even though rare, COVID-19 associated mucormycosis has been reported from across the world. We present a retrospective cases series of 132 patients diagnosed as COVID-19 associated mucormycosis in a tertiary care hospital in North India during May 9th to 30th 2021.

Materials and Methods: Our 1500 bed tertiary care hospital is one of the partners in the Mycotic Infections in COVID-19 (MUNCO) registry, Albert Einstein College of Medicine, Bronx, New York. Data were collected in the REDCap database. Profile of the patients has been presented according to demographic profile, comorbidities, laboratory parameters, ICU admission, oxygen support and treatment outcomes. Analysis of risk factors for mortality has been undertaken along with a prediction model for mortality.

Result: The proportion of males and females was 72.7% and 27.3% respectively. The mean age of the study subjects was 53.1 years. The major comorbidity was Diabetes (57.6%) followed by Hypertension (40.9%) and Coronary artery disease (11.4%). About 13% patients used long term corticosteroid. Further, 70.5% patients required an ICU admission and 47.0% patients required oxygen support whereas ventilator requirement was for 13.6% patients. Overall death rate of mucormycosis patients was 16.7%. The risk factors identified for death were raised levels of CRP >73, Ferritin >358, SGOT >39 and Creatinine >1.15 as well as oxygen requirement.

Conclusion: Clinicians must examine the possibility of concomitant fungal infection in COVID-19 patients especially who are geriatric or comorbid with Diabetes Mellitus. Those with raised levels of CRP, Ferritin, SGOT and Creatinine levels as well as those needing oxygen need to be vigilantly monitored to minimize the risk of mortality.

Keywords: Coronavirus disease; Mucormycosis; CAM; Fungal infections


Mucormycosis has been reported in patients suffering from covid-19 which is described as COVID-19 Associated Mucormycosis (CAM) [1]. According to the World Health Organization (WHO), mucormycosis is a rare but serious angio-invasive infection caused by a group of fungi called mucormycetes [2]. CAM has been detected mainly in patients with pre-existing conditions, such as diabetes mellitus, diabetic ketoacidosis, hematological malignancies, transplantation, and prolonged neutropenia or on corticosteroids [3].

Across the globe, the highest number of mucormycosis cases has been observed in India with more than 4,000 cases with COVID-19 associated mucormycosis [4]. Herein, we describe a case series of 132 patients with mucormycosis associated with COVID-19 infection.

Materials and Methods

This was a retrospective study of all hospitalized cases of mucormycosis associated with COVID-19 infection admitted to a tertiary, 1500-bed hospital, NCR, India during the month of May 2021, immediately following the second peak of COVID (March- April 2021). The patients diagnosed with mucormycosis were identified with a positive KOH mount and associated clinical features suggestive of fungal infection. Our tertiary care hospital is one of the partners in the Mycotic Infections in COVID-19 (MUNCO) registry, Albert Einstein College of Medicine, Bronx, New York wherein data were collected in the REDCap database. Study was approved by the Institutional Ethics Committee (MICR No: 1315/2021 dated June 17, 2021) and registered with the Clinical Trial Registry of India (NCT04935463).

The statistical analysis included profiling of patients on different demographic, preexisting comorbidities, laboratory parameters, ICU procedure, oxygen support requirement and treatment outcomes. Quantitative parameters were expressed as mean and standard deviation and categorical as absolute number and percentage. Student t-test and One Way ANOVA was used for testing of difference in mean between groups. Chi square test was used for testing of associations. The diagnostic accuracy of risk factors in predicting unfavorable outcome were assessed by receiver operating characteristic (ROC) curve analysis and obtained the optimal cut-off value with the best combination of sensitivity and specificity. Univariate logistic regression analysis was used to explore the association between explanatory variables and unfavorable outcomes. The variables showing significant association on univariate logistic regression analysis were considered in step wise multivariate logistic regression analysis. Importantly, a predictive model for risk of death has been developed based on significant risk factors as revealed by step wise multivariate logistic regression. The predictive power of the model has also been assessed. P-value <0.05 was considered statistically significant. All analysis was done using SPSS software, version 24.0.


A total of 132 patients diagnosed with COVID-19 associated mucormycosis admitted in our hospital between May 9th to May 30th 2021. Out of 132 patients, 40 (30.3%) were diagnosed with Sino-orbital mucormycosis (SOM), 75 (56.8%) with rhino-cerebral mucormycosis (RCM) and 17 (12.8%) had pulmonary (PM) involvement (Table 1).