Glucocorticoid, zinc supplement caused Covid-associated mucormycosis (CAM): Study

Naina Mishra

Chandigarh, December 20

A study published in Centers for Disease Control and Prevention (CDC) on Covid-associated mucormycosis (CAM) from 25 hospitals in India, including the PGI here, has found that glucocorticoid use and zinc supplementation in the treatment of Covid-19 were significantly associated with CAM.

A case-control study carried out across 25 hospitals in India, including the PGI, Chandigarh, for the period of January-June last year to evaluate the reasons for a large number of Covid-associated mucormycosis (CAM) was conducted.

The study investigated whether Covid-19 treatment practices (glucocorticoids, zinc, tocilizumab, and others) were associated with CAM. As many as 1,733 cases of CAM were enrolled in the study.

The study found cumulative glucocorticoid dose and zinc supplementation, along with elevated C-reactive protein (inflammation in body), and factors such as renal transplantation, diabetes mellitus, diabetic ketoacidosis during Covid spread significantly associated with CAM.

The mortality rate of CAM at 12 weeks was 32.2 per cent. The study has emphasised the judicious use of Covid-19 therapies and optimal glycemic control to prevent CAM.

During the second wave of the pandemic (April–June, 2021), a large number of cases of CAM were reported primarily in India. The explanation for this outbreak of CAM in India had remained unclear. Diabetes mellitus and glucocorticoids (used for treating Covid-19) were then identified as risk factors for CAM.

In this large case-control study, the researchers find that unprecedented rise in the number of CAM cases during the second wave of the pandemic indicates that Covid-19 or its treatment had a role in causing CAM.

The results of the study have strengthened the current recommendation of avoiding glucocorticoid use in Covid-19 patients not experiencing hypoxemia (low oxygen in blood). More critically, the study found that the cumulative glucocorticoid dose is also a contributory factor for CAM. Thus, even in hypoxemic Covid-19 patients, glucocorticoids should be used judiciously.

The wide variation in prescription practice, over-the-counter availability of drugs, and use of different formulations and dosages have established a dose-response relationship between zinc and CAM.

Mucormycosis cases during 2nd Covid wave

During the second wave of the pandemic (April–June, 2021), a large number of cases of Covid-associated mucormycosis (CAM) were reported primarily in India. The explanation for this outbreak of CAM in India had remained unclear. Diabetes mellitus and glucocorticoids (used for treating Covid-19) were then identified as risk factors for CAM.