DOI: http://dx.doi.org/10.18203/2319-2003.ijbcp20214116

Clinical outcome and toxicity in post-COVID suspected cases of mucormycosis treated with amphotericin B at dedicated COVID hospital: a prospective observational study

Teli Sheikh Emaran Sheikh Ismail, Chetan Bhangale, Jaiprakash Ramanand, Harshal Mahajan

Abstract


Background: Recently, several cases of mucormycosis in people with COVID-19 have been increasingly reported world-wide, in particular from India. Lipid formulations of amphotericin B are often used as first-line treatment. Present study aims to assess and analyze clinical outcome and toxicity in post-COVID suspected cases of mucormycosis treated with amphotericin B at dedicated COVID hospital.

Methods: The present study was a prospective observational study conducted at government medical college, Jalgaon which was a dedicated COVID hospital. Clinically suspected cases of mucormycosis treated with Amphotericin B were included in the study. We collected the data of previous treatment records, demographics, comorbidities, laboratory investigations and clinical outcome from the case files of patients admitted with diagnosis of clinically suspected mucormycosis with history of COVID-19 infection.

Results: Out of 57 patients, majority of them belonged to age group of 51-60 years comprising of 21 patients (37%) and 86% had involvement of one or more paranasal sinus/es. On analyzing prescription pattern and outcomes in patients of present study, it was found that majority of the patients had recovered completely comprising of 40 patients (70%), of which 21 patients (37%) had received liposomal amphotericin B, followed by lipid emulsion amphotericin B in 12 patients (21%).

Conclusions: The present study was first of its kind to analyze the prescribing trend of amphotericin B and outcomes in clinically suspected post-COVID cases of mucormycosis. Liposomal amphotericin B was found to be more effective and safer in terms of better recovery rate and less adverse events.

 


Keywords


COVID-19, Mucormycosis, Liposomal, Amphotericin B, Outcome

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References


Black fungus: These 5 states account for over 65% of India's 11,717 mucormycosis cases. 2021. Available at: https://www.livemint.com/news/india/black-fungus-these-5-states-account-for-60-ofindia-5-11-700-mucormycosis-cases-11622018575067.html. Accessed on 11 August, 2021.

For Healthcare Professionals Mucormycosis CDC. 2021. Available at: https://www.cdc.gov/fungal/diseases/mucormycosis/healthprofessionals.html. Accessed on 9 August, 2021.

Singh A, Singh R, Joshi S, Misra A. Mucormycosis in COVID-19: A systematic review of cases reported worldwide and in India. Diabetes Metab Syndr Clin Res Rev. 2021. Available at: https://linkinghub.elsevier.com/retrieve/pii/S1871402121001570. Accessed on 31 May, 2021.

Cornely O, Alastruey-Izquierdo A, Arenz D, Chen S, Dannaoui E, Hochhegger B et al. Global guideline for the diagnosis and management of mucormycosis: an initiative of the European Confederation of Medical Mycology in cooperation with the Mycoses Study Group Education and Research Consortium. Lancet Infect Dise. 2019;19:e405-21.

Gupta N, Kapre M, Gupta H, Vaidya G, Jani S, Meshram S et al. Risk Based Decision Algorithms for Management of COVID-19 Associated Rhino-orbital Mucormycosis. Indian J Otolaryngol Head Neck Surg. 2021;1-8.

Muthu V, Agarwal R, Dhooria S, Sehgal I, Prasad K, Aggarwal A et al. Has the mortality from pulmonary mucormycosis changed over time? A systematic review and meta-analysis. Clin Microbiol Infect. 2021;27(4):538-49.

Patel A, Kaur H, Xess I, Michael J, Savio J, Rudramurthy S et al. A multicentre observational study on the epidemiology, risk factors, management and outcomes of mucormycosis in India. Clin Microbiol Infect. 2020;26(7):944,e9-15.

Banerjee M, Pal R, Bhadada S. Intercepting the deadly trinity of mucormycosis, diabetes and COVID-19 in India. Postgrad Med J. 2021;1-.

Sharma S, Grover M, Bhargava S, Samdani S, Kataria T. Post coronavirus disease mucormycosis: a deadly addition to the pandemic spectrum. J Laryngol Otol. 2021;1-6.

Hamill R. Amphotericin B formulations: a comparative review of efficacy and toxicity. Drugs. 2013;73(9):919-34.