Clinical profile and outcome of COVID-19 associated mucormycosis in Shiraz, South Iran: a longitudinal study

Pariya Kouhi; Seyed Alireza Mirhosseini; Maryam Ranjbar; Mohammadreza Akbari; Zeinab Mehrabi; Rojan Javaheri; Mahsa Moosavi; Mohammad Alishahi; Kamran Rasekh; Nazanin Fathi; Yasaman Mansoori

doi:10.18502/ijm.v18i1.20940

Pariya Kouhi Department of Internal Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
Seyed Alireza Mirhosseini Department of MD-MPH, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
Maryam Ranjbar Department of MD-MPH, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
Mohammadreza Akbari Department of Internal Medicine, Shiraz Nephro-Urology Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
Zeinab Mehrabi Department of Internal Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
Rojan Javaheri Department of Internal Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
Mahsa Moosavi Department of Education, Clinical Education Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
Mohammad Alishahi Department of Internal Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
Kamran Rasekh Department of Infectious Disease, Ali Asghar Hospital, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
Nazanin Fathi Department of Internal Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
Yasaman Mansoori Department of Research, Health Policy Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

DOI: https://doi.org/10.18502/ijm.v18i1.20940

Keywords: COVID-19; Mucormycosis; Risk factors; Comorbidity; Treatment outcome; Prognosis

Abstract

Background and Objectives: Numerous cases of mucormycosis appeared among COVID-19 patients, predominant- ly in Asian countries. This study aimed to investigate the clinical profile, in-hospital outcome, and one-year prognosis of COVID-19-associated mucormycosis (CAM).

Materials and Methods: All patients who developed CAM in Shiraz, South Iran, between July and October 2021 were included in this study. We collected data on presentations, comorbidities, risk factors, and outcomes.

Results: Sixty-two patients with CAM were analyzed; the mean age was 59.3 years, and 58.1% were male. Diabetes mel- litus was present in 80.6% (11.2% uncontrolled), hypertension in 54.8%, and chronic kidney disease in 11.3%. All patients had sinonasal involvement; ophthalmic, cutaneous, cerebral, gastrointestinal, pulmonary, and renal involvement occurred in 41.9%, 8.1%, 6.4%, 6.4%, 1.6%, and 1.6%, respectively. In-hospital and one-year mortality were 40.3% and 48.3%. Concur- rent CAM and COVID-19, hypertension, older age, and radiologically severe COVID-19 lung involvement were associated with higher mortality. In multivariable analysis, age ≥60 years predicted in-hospital (OR: 5.47; 95% CI: 1.53-19.56) and one-year mortality (OR: 7.65; 95% CI: 1.90-30.84). Long-term mortality was also associated with ≥3 risk factors (OR: 4.12; 95% CI: 1.09-15.52) and lung severity index >30 (OR: 9.35; 95% CI: 1.01-86.63).

Conclusion: These findings emphasize the critical role of age in immune responses to opportunistic infections and highlight the impact of multiple comorbidities and severe lung damage on long-term prognosis in CAM.