Study of Management of Mucormycosis in COVID and Post-COVID Patients with Liposomal Amphotericin B its Outcome and Complications in a dedicated COVID Hospital from Eastern India
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Keywords
Mucormycosis,, COVID-19, Liposomal Amphotericin B,, Treatment outcomes, Complications
Abstract
Background: Mucormycosis, an invasive fungal infection caused by Mucorales, has emerged as a significant concern in COVID-19 patients, particularly in regions heavily affected by the pandemic. Liposomal Amphotericin B is the primary treatment modality for mucormycosis; however, data on its efficacy and safety in COVID-19-associated mucormycosis are limited. This prospective observational study aimed to evaluate the management of mucormycosis in COVID-19 and post-COVID patients treated with Liposomal Amphotericin B at a dedicated COVID-19 hospital in IGIMS, Patna from Eastern India. Primary objectives were the study of liposomal amphotericin for the initial treatment of mucormycosis and treatment outcomes. The secondary objective was to study various complications of Liposomal Amphotericin B therapy.
Methodology: In total, 121 adult patients diagnosed with mucormycosis and either active COVID-19 infection or in the post-COVID recovery phase were included in the study. The treatment outcomes, complications, and factors influencing patient prognosis were assessed. Data analysis was performed using SPSS statistical software, including logistic regression and Cox Proportional Hazards modelling.
Results: Most patients achieved resolution of mucormycosis infection (70.2%), but the mortality rate was notable at 24.8%. Adverse events including nephrotoxicity (20.7%), infusion-related reactions (12.4%), and electrolyte imbalances (33.1%) were prevalent. Logistic regression analysis identified that older age (p = 0.002), diabetes (p = 0.01), delayed treatment initiation (p = 0.001), higher doses of Amphotericin B (p = 0.04), and pre-existing renal impairment (p = 0.01) were significant predictors of treatment outcomes. Cox Proportional Hazards modelling showed a trend towards improved outcomes with longer treatment duration (p = 0.06).
Conclusion: This study provides added information into the management of mucormycosis in COVID-19 patients treated with Liposomal Amphotericin B. Despite achieving a relatively high-resolution rate, the significant mortality and complication rates underscore the challenges in managing this fungal infection.
References
2. Mallah SI, Ghorab OK, Al-Salmi S, Abdellatif OS, Tharmaratnam T, Iskandar MA et al. COVID-19: breaking down a global health crisis. Ann Clin Microbiol Antimicrob. 2021 May 18;20(1):35. doi: 10.1186/s12941-021-00438-7.
3. Mahalaxmi I, Jayaramayya K, Venkatesan D, Subramaniam MD, Renu K, Vijayakumar P, et al. Mucormycosis: An opportunistic pathogen during COVID-19. Environ Res. 2021 Oct;201:111643. doi: 10.1016/j.envres.2021.111643.
4. García-Carnero LC, Mora-Montes HM. Mucormycosis and COVID-19-Associated Mucormycosis: Insights of a Deadly but Neglected Mycosis. J Fungi (Basel). 2022 Apr 25;8(5):445. doi: 10.3390/jof8050445.
5. Sharma A, Goel A. Mucormycosis: risk factors, diagnosis, treatments, and challenges during COVID-19 pandemic. Folia Microbiol (Praha). 2022 Jun;67(3):363-387. doi: 10.1007/s12223-021-00934-5.
6. Dam P, Cardoso MH, Mandal S, Franco OL, Sağıroğlu P, Polat OA et al. Surge of mucormycosis during the COVID-19 pandemic. Travel Med Infect Dis. 2023 Mar-Apr;52:102557. doi: 10.1016/j.tmaid.2023.102557. Epub 2023 Feb 20.
7. Sahu RK, Salem-Bekhit MM, Bhattacharjee B, Almoshari Y, Ikbal AMA, Alshamrani M et al. Mucormycosis in Indian COVID-19 Patients: Insight into Its Patho-Genesis, Clinical Manifestation, and Management Strategies. Antibiotics (Basel). 2021 Sep 6;10(9):1079. doi: 10.3390/antibiotics10091079.
8. Arjmand P, Bahrami M, Mohammadie ZE, Taherynejad M, Khorasani NY, Mehrad-Majd H et al. Mucormycosis in pre-COVID-19 and COVID-19 era: A study of prevalence, risk factors and clinical features. Laryngoscope Investig Otolaryngol. 2022 Sep 7;7(5):1343–50. doi: 10.1002/lio2.899.
9. Selarka L, Sharma S, Saini D, Sharma S, Batra A, Waghmare VT et al. Mucormycosis and COVID-19: An epidemic within a pandemic in India. Mycoses. 2021 Oct;64(10):1253-1260. doi: 10.1111/myc.13353.
10. Shah NN, Khan Z, Ahad H, Elderdery AY, Alomary MN, Atwah B et al. Mucormycosis an added burden to Covid-19
Patients: An in-depth systematic review. J Infect Public Health. 2022 Nov;15(11):1299-1314. doi: 10.1016/j.jiph.2022.10.011. Epub 2022 Oct 14.
11. Moen MD, Lyseng-Williamson KA, Scott LJ. Liposomal amphotericin B: a review of its use as empirical therapy in febrile neutropenia and in the treatment of invasive fungal infections. Drugs. 2009;69(3):361-92. doi: 10.2165/00003495-200969030-00010.
12. Chillana S, Mohit Chilana KA. COVID-19 and Mucormycosis: A Black Fungus Disaster? Indian J Dermatol. 2022 Sep-Oct;67(5):535-538. doi: 10.4103/ijd.ijd_17_22.
13. Yasmin F, Najeeb H, Naeem A, Dapke K, Phadke R, Asghar MS et al. COVID-19 Associated Mucormycosis: A Systematic Review from Diagnostic Challenges to Management. Diseases. 2021 Sep 22;9(4):65. doi: 10.3390/diseases9040065.
14. Kumari A, Rao NP, Patnaik U, Malik V, Tevatia MS, Thakur S et al. Management outcomes of mucormycosis in COVID-19 patients: A preliminary report from a tertiary care hospital. Med J Armed Forces India. 2021 Jul;77(Suppl 2):S289-S295. doi: 10.1016/j.mjafi.2021.06.009. Epub 2021 Jul 26.
15. Sharma A, Goel A. Mucormycosis: risk factors, diagnosis, treatments, and challenges during COVID-19 pandemic. Folia Microbiol (Praha). 2022 Jun;67(3):363-387. doi: 10.1007/s12223-021-00934-5.
16. Khanna M, Challa S, Kabeil AS, Inyang B, Gondal FJ, Abah GA et al. Risk of Mucormycosis in Diabetes Mellitus: A Systematic Review. Cureus. 2021 Oct 16;13(10):e18827. doi: 10.7759/cureus.18827.
17. SeyedAlinaghi S, Karimi A, Barzegary A, Pashaei Z, Afsahi AM, Alilou S et al. Mucormycosis infection in patients with COVID-19: A systematic review. Health Sci Rep. 2022 Feb 28;5(2):e529. doi: 10.1002/hsr2.529.
18. Azhar A, Khan WH, Khan PA, Alhosaini K, Owais M, Ahmad A. Mucormycosis and COVID-19 pandemic: Clinical and diagnostic approach. J Infect Public Health. 2022 Apr;15(4):466-479. doi: 10.1016/j.jiph.2022.02.007.
19. Fanos V, Cataldi L. Amphotericin B-induced nephrotoxicity: a review. J Chemother. 2000 Dec;12(6):463-70. doi: 10.1179/joc.2000.12.6.463.
20. Barroso A, Estevinho F, Hespanhol V, Teixeira E, Ramalho-Carvalho J, Araújo A. Management of infusion-related reactions in cancer therapy: strategies and challenges. ESMO Open. 2024 Mar;9(3):102922. doi: 10.1016/j.esmoop.2024.102922.
21. Karimzadeh I, Heydari M, Ramzi M, Sagheb MM. Frequency and Associated Factors of Amphotericin B Nephrotoxicity in Hospitalized Patients in Hematology-Oncology Wards in the Southwest of Iran. Nephrourol Mon. 2016 Jul 3;8(5):e39581. doi: 10.5812/numonthly.39581.
22. Solanki NM, Solanki RN, Madaliya AV, Jasoliya RH, Upadhyay DT. COVID-19-associated mucormycosis: an update of anaesthetic management. Ain-Shams J Anesthesiol. 2022;14(1):16. doi: 10.1186/s42077-022-00216-3.
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