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Transpl Infect Dis
. 2021 Dec 21.
doi: 10.1111/tid.13777. Online ahead of print.
Risk factors and outcomes of COVID associated mucormycosis in kidney transplant recipients
Shyam B Bansal 1 , Abhyuday Rana 1 , Mayur Babras 1 , Dinesh Yadav 1 , Pranaw Jha 1 , Manish Jain 1 , Sidharth K Sethi 1
Affiliations
- PMID: 34932870
- DOI: 10.1111/tid.13777
Abstract
Background: Invasive Mucormycosis (IM) is a life-threatening fungal infections occurring mostly in solid organ transplant (SOT)recipients, patients with haematological malignancies, and diabetes. A sudden spurt of mucormycosis has been reported in severe acute respiratory syndrome coronavirus-2 (SARS-COV2) 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 Kidney transplant recipients (KTRs) post COVID 19 infection from February 2020 to June 2021 at a single centre 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 ha 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 patient 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: Invasive Mucormycosis 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 COVID associated mucormycosis. Judicious use of steroids and control of hyperglycemia is key to avoid flaring up of the fungal infection. This article is protected by copyright. All rights reserved.
Keywords: CAM; COVID 19 infection; invasive fungal infection; kidney transplant; mucormycosis.