CDC urges clinicians to be vigilant about COVID-related fungal infection

From Sept. 17-24, nine patients in Arkansas had mucormycosis, a sometimes fatal fungal infection, following a COVID-19 diagnosis, the CDC reported Dec. 16.

This September, three clinicians independently alerted the Arkansas Department of Health of multiple patients with mucormycosis after a recent diagnosis of COVID-19.  

Mucormycosis is an uncommon but severe invasive infection caused by molds. Mucormycosis typically affects people with immunocompromising conditions. The emergence of COVID-19-associated mucormycosis has been reported in other countries, particularly in India, but is infrequently seen in the U.S. COVID-19 may increase mucormycosis risk because of COVID-19-induced immune dysregulation or associated treatments that impair host defenses.

Cases were considered COVID-19-associated if the patient tested positive for COVID-19 during the 60 days before mucormycosis diagnosis.  

Ten COVID-19-associated mucormycosis cases occurring July 12 to Sept. 28, 2021, were reported to ADH by six hospitals. Nine patients lived in Arkansas and one lived in a nearby state. Median patient age was 57 years, with ages ranging from 17 to 78 years. All patients were non-Hispanic white, seven were male, one had a history of solid organ transplantation, and one had a recent traumatic injury at the body site where mucormycosis later developed. Eight patients had diabetes. None of the patients were vaccinated against COVID-19.

The median interval from COVID-19 diagnosis to mucormycosis was 18.5 days.

Mucormycosis clinical signs and symptoms included those that were rhino-orbital (four patients), pulmonary (three), disseminated (two), and gastrointestinal (one). COVID-19 treatment included supplemental oxygen therapy (eight patients), invasive mechanical ventilation (five), corticosteroids (nine), tocilizumab (two), and baricitinib (two). Five patients received surgical treatment to remove affected tissue. During hospitalization, three patients with diabetes experienced diabetic ketoacidosis. Six of the 10 patients died.

Because of the infection's severity, the CDC is urging clinicians to maintain a high index of suspicion for COVID-19-associated mucormycosis, including in patients without immunocompromising conditions. Treatment guidelines recommend prompt antifungal therapy and surgical intervention.  


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