Baseline findings of a multicentric ambispective cohort study (2021–2022) among hospitalised mucormycosis patients in India

ABSTRACT

In India, the incidence of mucormycosis reached high levels during 2021–2022, coinciding with the COVID-19 pandemic. In response to this, we established a multicentric ambispective cohort of patients hospitalised with mucormycosis across India. In this paper, we report their baseline profile, clinical characteristics and outcomes at discharge. Patients hospitalized for mucormycosis during March–July 2021 were included. Mucormycosis was diagnosed based on mycological confirmation on direct microscopy (KOH/Calcofluor white stain), culture, histopathology, or supportive evidence from endoscopy or imaging. After consent, trained data collectors used medical records and telephonic interviews to capture data in a pre-tested structured questionnaire. At baseline, we recruited 686 patients from 26 study hospitals, of whom 72.3% were males, 78% had a prior history of diabetes, 53.2% had a history of corticosteroid treatment, and 80% were associated with COVID-19. Pain, numbness or swelling of the face were the commonest symptoms (73.3%). Liposomal Amphotericin B was the commonest drug formulation used (67.1%), and endoscopic sinus surgery was the most common surgical procedure (73.6%). At discharge, the disease was stable in 43.3%, in regression for 29.9% but 9.6% died during hospitalization. Among survivors, commonly reported disabilities included facial disfigurement (18.4%) and difficulties in chewing/swallowing (17.8%). Though the risk of mortality was only 1 in 10, the disability due to the disease was very high. This cohort study could enhance our understanding of the disease’s clinical progression and help frame standard treatment guidelines.

KEYWORDS:

• Mucormycosis
• India
• cohort
• hospitalisation
• COVID-19
• survival

Acknowledgments

We are incredibly grateful to the members of the cohort and their families for their participation in this study. We sincerely acknowledge the contributions of our team of dedicated field staff and data entry operators for their commendable work. We also thank Ms Nandhini P, Ms Kavitha Mahalingam, and Mr Sathishkumar Sundararajan from ICMR-NIE for their data management and analysis support. We thank the anonymous reviewers whose comments have greatly improved our manuscript.

All India Mucormycosis Consortium Authors and affiliations.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The work was supported by the ICMR-National Institute of Epidemiology.