Risk factors and outcomes of COVID associated mucormycosis in kidney transplant recipients

• Published in: Transplant infectious disease 2022-04, Vol.24 (2), p.e13777-n/a
• Main Authors: Bansal, Shyam B., Rana, Abhyuday, Babras, Mayur, Yadav, Dinesh, Jha, Pranaw, Jain, Manish, Sethi, Sidharth K.
• Format: Article
• Language: English
• Subjects: Amphotericin B; Antifungal Agents - therapeutic use; CAM; Coronaviruses; COVID-19; COVID‐19 infection; Creatinine; Debridement; Diabetes; Diabetes mellitus; Diagnosis; Eye Infections, Fungal - diagnosis; Eye Infections, Fungal - drug therapy; Fungal infections; Fungi; Graft rejection; Health services; Humans; Hyperglycemia; invasive fungal infection; kidney transplant; Kidney transplantation; Kidney Transplantation - adverse effects; Kidney transplants; Kidneys; Mucormycosis; Mucormycosis - diagnosis; Mucormycosis - drug therapy; Mucormycosis - epidemiology; Orbital Diseases - diagnosis; Orbital Diseases - drug therapy; Pandemics; Patients; Posaconazole; Prophylaxis; Respiratory diseases; Risk analysis; Risk Factors; SARS-CoV-2; Severe acute respiratory syndrome; Severe acute respiratory syndrome coronavirus 2; Steroid hormones; Steroids; Sugar; Transplant Recipients; Viral diseases
• ISSN: 1398-2273; 1399-3062
• DOI: 10.1111/tid.13777

Background Invasive mucormycosis (IM) is a life‐threatening fungal infection occurring mostly in solid organ transplant (SOT) recipients, patients with hematological malignancies, and diabetes. A sudden spurt of mucormycosis has been reported in severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) pandemic in India; however, there is little data about coronavirus disease 2019 (COVID‐19) associated mucormycosis (CAM) in kidney transplant recipients (KTRs). Methods We describe the clinical presentations, risk factors, treatment and outcomes of 11 mucormycosis cases in KTRs post‐COVID‐19 infection from February 2020 to June 2021 at a single center in India. Results Mucormycosis was seen in 11/102 (10.7%) KTRs during the pandemic. Six patients had mild disease and rest five had moderate disease. Seven patients had pre‐existing diabetes mellitus and four developed new onset hyperglycemia after receiving steroids for COVID‐19 infection. All had poorly controlled sugars at the time of presentation. Most common presentation was rhino‐orbital‐cerebral mucormycosis (ROCM) in 10/11 (89%) patients and one has pulmonary mucormycosis. All patients received combination of amphotericin B and surgical debridement/excision of affected tissue followed by posaconazole prophylaxis. Nine patients recovered, however two patients succumbed to their illness after median of 14 (7–21) days from diagnosis. One patient developed acute T‐cell‐mediated rejection during the course of recovery. At last follow up, the mean serum creatinine was 2.05 mg/dl as compared to 1.4 mg/dl at presentation. Conclusions IM is a common fungal infection in transplant recipients in India after COVID‐19. Early diagnosis and prompt treatment with combination of surgical debridement and liposomal amphotericin B are key to better outcomes in CAM. Judicious use of steroids and control of hyperglycemia is key to avoid flaring up of the fungal infection.