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

Transpl Infect Dis. 2022 Apr;24(2):e13777. doi: 10.1111/tid.13777. Epub 2022 Jan 31.

Abstract

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.

Keywords: CAM; COVID-19 infection; invasive fungal infection; kidney transplant; mucormycosis.

MeSH terms

  • Antifungal Agents / therapeutic use
  • COVID-19*
  • Eye Infections, Fungal* / diagnosis
  • Eye Infections, Fungal* / drug therapy
  • Humans
  • Kidney Transplantation* / adverse effects
  • Mucormycosis* / diagnosis
  • Mucormycosis* / drug therapy
  • Mucormycosis* / epidemiology
  • Orbital Diseases* / diagnosis
  • Orbital Diseases* / drug therapy
  • Risk Factors
  • SARS-CoV-2
  • Transplant Recipients

Substances

  • Antifungal Agents