Abstract：
OBJECTIVE: Invasive fungal infections have recently become a public health problem, particularly in India following the second wave of coronavirus disease 2019 (COVID-19). India harbors the world\'s largest population of patients suffering from diabetes. What prompted the sudden spike of mucormycosis infections in the COVID pandemic needs investigation.
OBJECTIVE: To determine if COVID-19 infection prompted the spike in invasive fungal infections in diabetic population. To determine the long-term outcome of COVID-associated mucormycosis. To determine if COVID-19 infection causes diabetes mellitus transiently.
METHODS: The study was a prospective cohort study comprising patients suffering from mucormycosis. The study was planned from 20 May 2021, until 30 November 2022, to investigate the long-term follow-up (1 year) of mucormycosis patients.
METHODS: The study setting was a referral hospital.
METHODS: All the consecutive patients admitted to this hospital for treatment of mucormycosis were included in the study who consented to it. Intervention(s) (for clinical trials) or exposure(s) (for observational studies): All patients suffering with mucormycosis underwent treatment at this hospital with surgery and injectable systemic antifungal drugs alongside diabetes management.
METHODS: Primary outcome measurement was in the form of survival with cure of mucormycosis. Hypothesis being tested was formulated during data collection.
RESULTS: The data of 98 participants was collected, but analysis was done after excluding the case of cutaneous mucormycosis (infant patient). Mean age for patients was 55.5 years, varying from 28 to 88 years. In our study, 63.3% of patients with mucormycosis were males and 37.8% were females, of which 55.7% (34) and 58.3% (21) were known diabetics, respectively. Previous history of diabetes mellitus was identified as an underlying comorbid condition in 56.7% of patients, while the rest were diagnosed with new-onset diabetes mellitus. Sugar levels ranged (on admission) from 112 to 494 mg/dL (median 212 mg/dL) for known diabetics and from 132 to 356 mg/dL (median 204 mg/dL) for newly diagnosed diabetics. Other comorbidities included hypertension (19.5%), ischemic heart disease (8.2%), chronic renal illness (3.09%), and one case (1.03%) of postoperative renal cell carcinoma (disease-free). The majority of cases (91.8%) were not vaccinated for COVID-19, while only two patients reported a history of vaccination with two doses, and six others had received only a single dose. At the 1-year follow-up, 57.7% of cases were disease-free, 30.9% had expired, and 11.3% were lost to follow-up. The mean glycated hemoglobin (HbA1c) at the time of admission was found to be statistically significant when compared between known diabetics and newly diagnosed ones [confidence interval (CI)-95%, p ≤ 0.01]. A total of seven patients from the newly diagnosed diabetic group no longer required medicines for diabetes at the end of 1 year (CI-95%, p ≤ 0.01).
CONCLUSIONS: Diabetes mellitus, particularly with poor glycemic control, was the single most important factor associated with and predictor of outcome. Contrary to the popular hypothesis, industrial oxygen and oxygen masks were not the reasons for the mucormycosis pandemic. Additionally, immunization against COVID provided protection not only from severe COVID but also from COVID-associated mucormycosis. It is recommended that patients with mucormycosis be followed for longer periods as a few patients could be suffering from transient diabetes, particularly against the backdrop of a pandemic.
OBJECTIVE: To determine if COVID-19 infection prompted the spike in invasive fungal infections in diabetic population. To determine the long-term outcome of COVID-associated mucormycosis. To determine if COVID-19 infection causes diabetes mellitus transiently.
METHODS: The study was a prospective cohort study comprising patients suffering from mucormycosis. The study was planned from 20 May 2021, until 30 November 2022, to investigate the long-term follow-up (1 year) of mucormycosis patients.
METHODS: The study setting was a referral hospital.
METHODS: All the consecutive patients admitted to this hospital for treatment of mucormycosis were included in the study who consented to it. Intervention(s) (for clinical trials) or exposure(s) (for observational studies): All patients suffering with mucormycosis underwent treatment at this hospital with surgery and injectable systemic antifungal drugs alongside diabetes management.
METHODS: Primary outcome measurement was in the form of survival with cure of mucormycosis. Hypothesis being tested was formulated during data collection.
RESULTS: The data of 98 participants was collected, but analysis was done after excluding the case of cutaneous mucormycosis (infant patient). Mean age for patients was 55.5 years, varying from 28 to 88 years. In our study, 63.3% of patients with mucormycosis were males and 37.8% were females, of which 55.7% (34) and 58.3% (21) were known diabetics, respectively. Previous history of diabetes mellitus was identified as an underlying comorbid condition in 56.7% of patients, while the rest were diagnosed with new-onset diabetes mellitus. Sugar levels ranged (on admission) from 112 to 494 mg/dL (median 212 mg/dL) for known diabetics and from 132 to 356 mg/dL (median 204 mg/dL) for newly diagnosed diabetics. Other comorbidities included hypertension (19.5%), ischemic heart disease (8.2%), chronic renal illness (3.09%), and one case (1.03%) of postoperative renal cell carcinoma (disease-free). The majority of cases (91.8%) were not vaccinated for COVID-19, while only two patients reported a history of vaccination with two doses, and six others had received only a single dose. At the 1-year follow-up, 57.7% of cases were disease-free, 30.9% had expired, and 11.3% were lost to follow-up. The mean glycated hemoglobin (HbA1c) at the time of admission was found to be statistically significant when compared between known diabetics and newly diagnosed ones [confidence interval (CI)-95%, p ≤ 0.01]. A total of seven patients from the newly diagnosed diabetic group no longer required medicines for diabetes at the end of 1 year (CI-95%, p ≤ 0.01).
CONCLUSIONS: Diabetes mellitus, particularly with poor glycemic control, was the single most important factor associated with and predictor of outcome. Contrary to the popular hypothesis, industrial oxygen and oxygen masks were not the reasons for the mucormycosis pandemic. Additionally, immunization against COVID provided protection not only from severe COVID but also from COVID-associated mucormycosis. It is recommended that patients with mucormycosis be followed for longer periods as a few patients could be suffering from transient diabetes, particularly against the backdrop of a pandemic.
摘要：
目的：侵袭性真菌感染最近已成为一个公共卫生问题，特别是在2019年第二波冠状病毒病（COVID-19）之后的印度。印度拥有世界上最大的糖尿病患者人口。是什么促使COVID大流行中毛霉菌病感染突然激增，需要调查。
目的：确定COVID-19感染是否促使糖尿病人群侵袭性真菌感染激增。确定COVID相关性毛霉菌病的长期预后。确定COVID-19感染是否会短暂导致糖尿病。
方法：本研究是一项前瞻性队列研究，包括毛霉菌病患者。该研究计划于2021年5月20日至2022年11月30日，以调查毛霉菌病患者的长期随访（1年）。
方法：研究设置为转诊医院。
方法：所有连续入院治疗毛霉菌病的患者均纳入本研究。干预（用于临床试验）或暴露（用于观察性研究）：所有患有毛霉菌病的患者在该医院接受了手术和可注射的全身抗真菌药物以及糖尿病管理的治疗。
方法：主要结果测量是在毛霉菌病治愈后存活的形式。被检验的假设是在数据收集过程中提出的。
结果：收集了98名参与者的数据，但在排除皮肤毛霉菌病(婴儿患者)病例后进行了分析.患者平均年龄为55.5岁,从28岁到88岁不等。在我们的研究中,毛霉菌病63.3%为男性,37.8%为女性,其中55.7%(34)和58.3%(21)是已知的糖尿病患者，分别。在56.7%的患者中，既往糖尿病史被确定为潜在的合并症。其余患者被诊断为新发糖尿病。已知糖尿病患者的糖水平（入院时）为112至494mg/dL（中位数212mg/dL），新诊断的糖尿病患者的糖水平为132至356mg/dL（中位数204mg/dL）。其他合并症包括高血压（19.5%），缺血性心脏病（8.2%），慢性肾脏病(3.09%),术后肾细胞癌(无病)1例(1.03%)。大多数病例（91.8%）没有接种COVID-19疫苗，而只有两名患者报告有两剂疫苗接种史，另外六个人只接受了一次剂量。在1年的随访中，57.7%的病例为无病,30.9%已过期,11.3%的患者失去随访。入院时的平均糖化血红蛋白（HbA1c）在已知糖尿病患者和新诊断糖尿病患者之间进行比较时具有统计学意义[置信区间（CI）-95％，p≤0.01]。在1年结束时，新诊断的糖尿病组中共有7名患者不再需要糖尿病药物（CI-95％，p≤0.01)。
结论：糖尿病，尤其是血糖控制不佳，是与结果相关的最重要的因素和预测因素。与流行的假设相反，工业氧气和氧气面罩不是毛霉菌病大流行的原因。此外,针对COVID的免疫不仅提供了对严重COVID的保护，而且还提供了对COVID相关毛霉菌病的保护。建议对毛霉菌病患者进行更长时间的随访，因为少数患者可能患有短暂性糖尿病，特别是在大流行的背景下。
目的：确定COVID-19感染是否促使糖尿病人群侵袭性真菌感染激增。确定COVID相关性毛霉菌病的长期预后。确定COVID-19感染是否会短暂导致糖尿病。
方法：本研究是一项前瞻性队列研究，包括毛霉菌病患者。该研究计划于2021年5月20日至2022年11月30日，以调查毛霉菌病患者的长期随访（1年）。
方法：研究设置为转诊医院。
方法：所有连续入院治疗毛霉菌病的患者均纳入本研究。干预（用于临床试验）或暴露（用于观察性研究）：所有患有毛霉菌病的患者在该医院接受了手术和可注射的全身抗真菌药物以及糖尿病管理的治疗。
方法：主要结果测量是在毛霉菌病治愈后存活的形式。被检验的假设是在数据收集过程中提出的。
结果：收集了98名参与者的数据，但在排除皮肤毛霉菌病(婴儿患者)病例后进行了分析.患者平均年龄为55.5岁,从28岁到88岁不等。在我们的研究中,毛霉菌病63.3%为男性,37.8%为女性,其中55.7%(34)和58.3%(21)是已知的糖尿病患者，分别。在56.7%的患者中，既往糖尿病史被确定为潜在的合并症。其余患者被诊断为新发糖尿病。已知糖尿病患者的糖水平（入院时）为112至494mg/dL（中位数212mg/dL），新诊断的糖尿病患者的糖水平为132至356mg/dL（中位数204mg/dL）。其他合并症包括高血压（19.5%），缺血性心脏病（8.2%），慢性肾脏病(3.09%),术后肾细胞癌(无病)1例(1.03%)。大多数病例（91.8%）没有接种COVID-19疫苗，而只有两名患者报告有两剂疫苗接种史，另外六个人只接受了一次剂量。在1年的随访中，57.7%的病例为无病,30.9%已过期,11.3%的患者失去随访。入院时的平均糖化血红蛋白（HbA1c）在已知糖尿病患者和新诊断糖尿病患者之间进行比较时具有统计学意义[置信区间（CI）-95％，p≤0.01]。在1年结束时，新诊断的糖尿病组中共有7名患者不再需要糖尿病药物（CI-95％，p≤0.01)。
结论：糖尿病，尤其是血糖控制不佳，是与结果相关的最重要的因素和预测因素。与流行的假设相反，工业氧气和氧气面罩不是毛霉菌病大流行的原因。此外,针对COVID的免疫不仅提供了对严重COVID的保护，而且还提供了对COVID相关毛霉菌病的保护。建议对毛霉菌病患者进行更长时间的随访，因为少数患者可能患有短暂性糖尿病，特别是在大流行的背景下。
