Abstract：
BACKGROUND: Factors associated with pulmonary mucormycosis (PM) among subjects with diabetes mellitus (DM) remain unclear. Following the coronavirus disease (COVID-19)-associated mucormycosis outbreak in India, specific environmental exposures (especially cattle dung exposure) were proposed as possible aetiology. We hypothesized that environmental factors are associated with PM. We compared subjects with DM with (cases) and without PM (controls).
METHODS: In this case-control study, for each PM case, we included five unmatched diabetic controls (hospital [n = 2], community [n = 3]) without PM. We collected information on demography, COVID-19 infection, glycated haemoglobin% (HbA1c), the type of house (pucca vs. kutcha) where the participants reside, and other environmental factors. The primary exposure tested was cattle dung exposure (CDE; using cattle dung cakes as fuel or cattle handling). We performed a multivariate logistic regression to explore factors associated with PM and report the association as an adjusted odds ratio (OR) with 95% confidence intervals (CI).
RESULTS: We enrolled 39 PM cases and 199 controls (hospital [n = 80], community [n = 119]). CDE (OR 0.68, 95% CI [0.14-3.31]; p = 0.63) was not associated with increased PM in DM. We found male sex (OR 4.07, 95% CI [1.16-14.31]), higher HbA1c (OR 1.51, 95% CI [1.18-16.32]), COVID-19 (OR 28.25, 95% CI [7.02-113.6]) and residence at kutcha house (OR 4.84, 95% CI [1.33-17.52]) associated with PM.
CONCLUSIONS: Cattle dung exposure was not associated with PM in subjects with DM. Instead, male sex, poor glycaemic control, COVID-19 and the type of housing were associated with pulmonary mucormycosis.
METHODS: In this case-control study, for each PM case, we included five unmatched diabetic controls (hospital [n = 2], community [n = 3]) without PM. We collected information on demography, COVID-19 infection, glycated haemoglobin% (HbA1c), the type of house (pucca vs. kutcha) where the participants reside, and other environmental factors. The primary exposure tested was cattle dung exposure (CDE; using cattle dung cakes as fuel or cattle handling). We performed a multivariate logistic regression to explore factors associated with PM and report the association as an adjusted odds ratio (OR) with 95% confidence intervals (CI).
RESULTS: We enrolled 39 PM cases and 199 controls (hospital [n = 80], community [n = 119]). CDE (OR 0.68, 95% CI [0.14-3.31]; p = 0.63) was not associated with increased PM in DM. We found male sex (OR 4.07, 95% CI [1.16-14.31]), higher HbA1c (OR 1.51, 95% CI [1.18-16.32]), COVID-19 (OR 28.25, 95% CI [7.02-113.6]) and residence at kutcha house (OR 4.84, 95% CI [1.33-17.52]) associated with PM.
CONCLUSIONS: Cattle dung exposure was not associated with PM in subjects with DM. Instead, male sex, poor glycaemic control, COVID-19 and the type of housing were associated with pulmonary mucormycosis.
摘要：
背景：糖尿病（DM）患者中与肺毛霉菌病（PM）相关的因素尚不清楚。在印度爆发冠状病毒病（COVID-19）相关的毛霉菌病之后，特定的环境暴露（尤其是牛粪暴露）被认为是可能的病因。我们假设环境因素与PM相关。我们比较了有DM（病例）和无PM（对照）的受试者。
方法：在本病例对照研究中，对于每个PM案例，我们纳入了五个不匹配的糖尿病对照(医院[n=2]，社区[n=3])没有PM。我们收集了人口统计信息,COVID-19感染，糖化血红蛋白%（HbA1c），房子的类型(puccavs.kutcha)参与者居住的地方，和其他环境因素。测试的主要暴露是牛粪暴露（CDE；使用牛粪饼作为燃料或处理牛）。我们进行了多变量逻辑回归以探索与PM相关的因素，并将其关联报告为具有95％置信区间（CI）的校正比值比（OR）。
结果：我们登记了39个PM病例和199个对照（医院[n=80]，社区[n=119])。CDE(OR0.68,95%CI[0.14-3.31];p=0.63)与DM患者PM升高无关。我们发现男性(OR4.07，95%CI[1.16-14.31])，较高的HbA1c（OR1.51，95%CI[1.18-16.32]），COVID-19（OR28.25，95%CI[7.02-113.6]）和与PM相关的Kutcha房屋的住所（OR4.84，95%CI[1.33-17.52]）。
结论：在DM患者中，牛粪暴露与PM无关。相反，男性,血糖控制不佳，COVID-19和住房类型与肺毛霉菌病有关。
方法：在本病例对照研究中，对于每个PM案例，我们纳入了五个不匹配的糖尿病对照(医院[n=2]，社区[n=3])没有PM。我们收集了人口统计信息,COVID-19感染，糖化血红蛋白%（HbA1c），房子的类型(puccavs.kutcha)参与者居住的地方，和其他环境因素。测试的主要暴露是牛粪暴露（CDE；使用牛粪饼作为燃料或处理牛）。我们进行了多变量逻辑回归以探索与PM相关的因素，并将其关联报告为具有95％置信区间（CI）的校正比值比（OR）。
结果：我们登记了39个PM病例和199个对照（医院[n=80]，社区[n=119])。CDE(OR0.68,95%CI[0.14-3.31];p=0.63)与DM患者PM升高无关。我们发现男性(OR4.07，95%CI[1.16-14.31])，较高的HbA1c（OR1.51，95%CI[1.18-16.32]），COVID-19（OR28.25，95%CI[7.02-113.6]）和与PM相关的Kutcha房屋的住所（OR4.84，95%CI[1.33-17.52]）。
结论：在DM患者中，牛粪暴露与PM无关。相反，男性,血糖控制不佳，COVID-19和住房类型与肺毛霉菌病有关。
