Hyperglycemia and steroid use increase the risk of rhino-orbito-cerebral mucormycosis regardless of COVID-19 hospitalization: Case-control study, India.

BackgroundIn the ongoing COVID-19 pandemic, an increased incidence of ROCM was noted in India among those infected with COVID. We determined risk factors for rhino-orbito-cerebral mucormycosis (ROCM) post Coronavirus disease 2019 (COVID-19) among those never and ever hospitalized for COVID-19 separately through a multicentric, hospital-based, unmatched case-control study across India.MethodsWe defined cases and controls as those with and without post-COVID ROCM, respectively. We compared their socio-demographics, co-morbidities, steroid use, glycaemic status, and practices. We calculated crude and adjusted odds ratio (AOR) with 95% confidence intervals (CI) through logistic regression. The covariates with a p-value for crude OR of less than 0·20 were considered for the regression model.ResultsAmong hospitalised, we recruited 267 cases and 256 controls and 116 cases and 231 controls among never hospitalised. Risk factors (AOR; 95% CI) for post-COVID ROCM among the hospitalised were age 45-59 years (2·1; 1·4 to 3·1), having diabetes mellitus (4·9; 3·4 to 7·1), elevated plasma glucose (6·4; 2·4 to 17·2), steroid use (3·2; 2 to 5·2) and frequent nasal washing (4·8; 1·4 to 17). Among those never hospitalised, age ≥ 60 years (6·6; 3·3 to 13·3), having diabetes mellitus (6·7; 3·8 to 11·6), elevated plasma glucose (13·7; 2·2 to 84), steroid use (9·8; 5·8 to 16·6), and cloth facemask use (2·6; 1·5 to 4·5) were associated with increased risk of post-COVID ROCM.ConclusionsHyperglycemia, irrespective of having diabetes mellitus and steroid use, was associated with an increased risk of ROCM independent of COVID-19 hospitalisation. Rational steroid usage and glucose monitoring may reduce the risk of post-COVID

Correction: Hyperglycemia and steroid use increase the risk of rhino-orbito-cerebral mucormycosis regardless of COVID-19 hospitalization: Case-control study, India.

[This corrects the article DOI: 10.1371/journal.pone.0272042.]

Clinical status and management among those with diabetes mellitus (n, %), multi-centric case-control study of post COVID ROCM, India, 2021.

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Risk factors for mucormycosis among never-hospitalised COVID-19 patients, multi-centric case-control study of post-COVID rhino-orbito-cerebral mucormycosis, India, 2021.

Risk factors for mucormycosis among never-hospitalised COVID-19 patients, multi-centric case-control study of post-COVID rhino-orbito-cerebral mucormycosis, India, 2021.</p

Directed acyclic graph of Post COVID-19 rhino orbito cerebral mucormycosis for (a) ever-hospitalised and (b) never-hospitalised patients.

Directed acyclic graph of Post COVID-19 rhino orbito cerebral mucormycosis for (a) ever-hospitalised and (b) never-hospitalised patients.</p

Risk factors for mucormycosis among ever-hospitalised COVID-19 patients, multi-centric case-control study of post-COVID rhino-orbito-cerebral mucormycosis, India, 2021.

Risk factors for mucormycosis among ever-hospitalised COVID-19 patients, multi-centric case-control study of post-COVID rhino-orbito-cerebral mucormycosis, India, 2021.</p

Socio-demographic characteristics of the cases and controls, multi-centric case-control study of post-COVID rhino-orbito-cerebral mucormycosis, India, 2021.

Socio-demographic characteristics of the cases and controls, multi-centric case-control study of post-COVID rhino-orbito-cerebral mucormycosis, India, 2021.</p