Hostname: page-component-cd9895bd7-fscjk Total loading time: 0 Render date: 2024-12-23T07:57:22.315Z Has data issue: false hasContentIssue false

Decreased mortality in coronavirus disease 2019 associated mucormycosis with aspirin use: a retrospective cohort study

Published online by Cambridge University Press:  14 June 2022

Z Shaikh
Affiliation:
Department of ENT and Head and Neck Surgery, All India Institute of Medical Sciences, Bhubaneswar, India
S Sarkar*
Affiliation:
Department of ENT and Head and Neck Surgery, All India Institute of Medical Sciences, Bhubaneswar, India
R Biswas
Affiliation:
Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
A Adhikari
Affiliation:
Department of ENT and Head and Neck Surgery, All India Institute of Medical Sciences, Bhubaneswar, India
V K Hallur
Affiliation:
Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, India
P K Parida
Affiliation:
Department of ENT and Head and Neck Surgery, All India Institute of Medical Sciences, Bhubaneswar, India
C Preetam
Affiliation:
Department of ENT and Head and Neck Surgery, All India Institute of Medical Sciences, Bhubaneswar, India
P Pradhan
Affiliation:
Department of ENT and Head and Neck Surgery, All India Institute of Medical Sciences, Bhubaneswar, India
D K Samal
Affiliation:
Department of ENT and Head and Neck Surgery, All India Institute of Medical Sciences, Bhubaneswar, India
A Nayak
Affiliation:
Department of ENT and Head and Neck Surgery, All India Institute of Medical Sciences, Bhubaneswar, India
S Chadaram
Affiliation:
Department of ENT and Head and Neck Surgery, All India Institute of Medical Sciences, Bhubaneswar, India
K K Das
Affiliation:
Department of ENT and Head and Neck Surgery, All India Institute of Medical Sciences, Bhubaneswar, India
S Chakraborty
Affiliation:
Department of ENT and Head and Neck Surgery, All India Institute of Medical Sciences, Bhubaneswar, India
P Sharma
Affiliation:
Department of ENT and Head and Neck Surgery, All India Institute of Medical Sciences, Bhubaneswar, India
A K Veeti
Affiliation:
Department of ENT and Head and Neck Surgery, All India Institute of Medical Sciences, Bhubaneswar, India
V Karakkandy
Affiliation:
Department of ENT and Head and Neck Surgery, All India Institute of Medical Sciences, Bhubaneswar, India
A Mishra
Affiliation:
Department of ENT and Head and Neck Surgery, All India Institute of Medical Sciences, Bhubaneswar, India
Y Mittal
Affiliation:
Department of ENT and Head and Neck Surgery, All India Institute of Medical Sciences, Bhubaneswar, India
K S Chithambaram
Affiliation:
Department of ENT and Head and Neck Surgery, All India Institute of Medical Sciences, Bhubaneswar, India
A Swarup
Affiliation:
Department of ENT and Head and Neck Surgery, All India Institute of Medical Sciences, Bhubaneswar, India
S Chenniappan
Affiliation:
Department of ENT and Head and Neck Surgery, All India Institute of Medical Sciences, Bhubaneswar, India
A Shah
Affiliation:
Department of ENT and Head and Neck Surgery, All India Institute of Medical Sciences, Bhubaneswar, India
*
Author for correspondence: Dr S Sarkar, Department of ENT and Head and Neck Surgery, All India Institute of Medical Sciences, Bhubaneswar751019, India E-mail: [email protected]

Abstract

Objective

Rhino-orbito-cerebral mucormycosis is a rapidly progressive disease with high mortality rates of about 60 per cent. The increasing incidence of rhino-orbito-cerebral mucormycosis in coronavirus disease 2019 patients in India and worldwide has become a matter of concern owing to the case fatality rate. This study explored the use of low dose aspirin in decreasing the mortality rate of coronavirus disease 2019 associated mucormycosis.

Method

This was a retrospective observational study. Patients suffering from post-coronavirus disease 2019 mucormycosis were included in the study. Each patient was treated with surgical debridement and systemic amphotericin B. Low dose aspirin was added, and mortality rates were compared with the patients who did not receive aspirin.

Results

The demographic data and rhino-orbito-cerebral mucormycosis staging between the two groups were not significantly different. There was a statistically significant difference in mortality outcomes between the two groups (p = 0.029) and a 1.77 times higher risk of dying for patients not receiving aspirin. Kaplan–Meier survival indicated that patients receiving aspirin had better survival rates (p = 0.04).

Conclusion

Low dose aspirin improves survival rates in coronavirus disease 2019 associated mucormycosis.

Type
Main Article
Copyright
Copyright © The Author(s), 2022. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Dr S Sarkar takes responsibility for the integrity of the content of the paper

References

Frater, J, Hall, G, Procop, G. Histologic features of zygomycosis. Arch Pathol Lab Med 2001;125:375–8CrossRefGoogle ScholarPubMed
Roden, MM, Zaoutis, TE, Buchanan, WL, Knudsen, TA, Sarkisova, TA, Schaufele, RL et al. Epidemiology and outcome of zygomycosis: a review of 929 reported cases. Clin Infect Dis 2005;41:634–53CrossRefGoogle ScholarPubMed
Pradhan, P, Shaikh, Z, Mishra, A, Preetam, C, Parida, PK, Sarkar, S et al. Predisposing factors of rhino-orbital-cerebral mucormycosis in patients with Covid 19 infection. Indian J Otolaryngol Head Neck Surg 2021;34604021Google ScholarPubMed
Reid, G, Lynch, JP 3rd, Fishbein, MC, Clark, NM. Mucormycosis. Semin Respir Crit Care Med 2020;41:99114Google ScholarPubMed
Patel, AK, Patel, KK, Patel, K, Gohel, S, Chakrabarti, A. Mucormycosis at a tertiary care centre in Gujarat, India. Mycoses 2017;60:407–11CrossRefGoogle Scholar
Prakash, H, Chakrabarti, A. Epidemiology of mucormycosis in India. Microorganisms 2021;9:523CrossRefGoogle ScholarPubMed
Prakash, H, Chakrabarti, A. Global epidemiology of mucormycosis. J Fungi (Basel) 2019;5:26CrossRefGoogle ScholarPubMed
Jeong, W, Keighley, C, Wolfe, R, Lee, WL, Slavin, MA, Kong, DC et al. The epidemiology and clinical manifestations of mucormycosis: a systematic review and meta-analysis of case reports. Clin Microbiol Infect 2019;25:2634CrossRefGoogle ScholarPubMed
Morales-Franco, B, Nava-Villalba, M, Medina-Guerrero, EO, Sánchez-Nuño, YA, Davila-Villa, P, Anaya-Ambriz, EJ et al. Host-pathogen molecular factors contribute to the pathogenesis of Rhizopus spp. in diabetes mellitus. Curr Trop Med Rep 2021;8:112Google Scholar
Hernández, JL, Buckley, CJ. Mucormycosis. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2021Google Scholar
Honavar, SG. Code mucor: guidelines for the diagnosis, staging and management of rhino-orbito-cerebral mucormycosis in the setting of Covid-19. Ind J Ophthalmol 2021;69:1361–5CrossRefGoogle ScholarPubMed
Sen, M, Honavar, SG, Sharma, N, Sachdev, MS. Covid-19 and eye: a review of ophthalmic manifestations of Covid-19. Ind J Ophthalmol 2021;69:488509Google Scholar
Ahmadikia, K, Hashemi, SJ, Khodavaisy, S, Getso, MI, Alijani, N, Badali, H et al. The double-edged sword of systemic corticosteroid therapy in viral pneumonia: a case report and comparative review of influenza-associated mucormycosis versus Covid-19 associated mucormycosis. Mycoses 2021;64:798808CrossRefGoogle ScholarPubMed
Veisi, A, Bagheri, A, Eshaghi, M, Rikhtehgar, MH, Rezaei Kanavi, M, Farjad, R. Rhino-orbital mucormycosis during steroid therapy in Covid-19 patients: a case report. Eur J Ophthalmol 2021;11206721211009450Google ScholarPubMed
Skiada, A, Lass-Floerl, C, Klimko, N, Ibrahim, A, Roilides, E, Petrikkos, G. Challenges in the diagnosis and treatment of mucormycosis. Med Mycol 2018;56(suppl 1):S93101CrossRefGoogle ScholarPubMed
Herbrecht, R, Letscher-Bru, V, Bowden, RA, Kusne, S, Anaissie, EJ, Graybill, JR et al. Treatment of 21 cases of invasive mucormycosis with amphotericin B colloidal dispersion. Eur J Clin Microbiol Infect Dis 2001;20:460–6CrossRefGoogle ScholarPubMed
Talasaz, AH, Sadeghipour, P, Kakavand, H, Aghakouchakzadeh, M, Kordzadeh-Kermani, E, Van, TBW et al. Recent randomized trials of antithrombotic therapy for patients with Covid-19. J Amer Coll Cardiol 2021;77:1903–21CrossRefGoogle ScholarPubMed
Libby, P, Lüscher, T. Covid-19 is, in the end, an endothelial disease. Eur Heart J 2020;41:3038–44CrossRefGoogle ScholarPubMed
Giustino, G, Pinney, SP, Lala, A, Reddy, VY, Johnston-Cox, HA, Mechanick, JI et al. Coronavirus and cardiovascular disease, myocardial injury, and arrhythmia: JACC focus seminar. J Amer Coll Cardiol 2020;76:2011–23CrossRefGoogle ScholarPubMed
Siddiqi, HK, Libby, P, Ridker, PM. Covid-19 – a vascular disease. Trends Cardiovasc Med 2021;31:15CrossRefGoogle ScholarPubMed
Koupenova M. Potential role of platelets in Covid-19: implications for thrombosis. Res Pract Thromb Haemost 2020;4:737–40CrossRefGoogle Scholar
Wang, Y, Wang, Y, Chen, Y, Qin, Q. Unique epidemiological and clinical features of the emerging 2019 novel coronavirus pneumonia (Covid-19) implicate special control measures. J Med Virol 2020;92:568–76CrossRefGoogle ScholarPubMed
Klok, FA, Kruip, MJ, Van der Meer, NJ, Arbous, MS, Gommers, DA, Kant, KM et al. Confirmation of the high cumulative incidence of thrombotic complications in critically ill ICU patients with Covid-19: an updated analysis. Thromb Res 2020;191:148–50CrossRefGoogle ScholarPubMed
Oxley, TJ, Mocco, J, Majidi, S, Kellner, CP, Shoirah, H, Singh, IP et al. Large-vessel stroke as a presenting feature of Covid-19 in the young. New Engl J Med 2020;382:e60CrossRefGoogle ScholarPubMed
McFadyen, JD, Stevens, H, Peter, K. The emerging threat of (micro)thrombosis in Covid-19 and its therapeutic implications. Circ Res 2020;127:571–87CrossRefGoogle ScholarPubMed
Vaughan, DE, Lazos, SA, Tong, K. Angiotensin II regulates the expression of plasminogen activator inhibitor-1 in cultured endothelial cells. A potential link between the renin-angiotensin system and thrombosis. J Clin Investig 1995;95:9951001CrossRefGoogle ScholarPubMed
Ali, MAM, Spinler, SA. Covid-19 and thrombosis: from bench to bedside. Trends Cardiovasc Med 2021;31:143–60CrossRefGoogle ScholarPubMed
Fanfair R, Neblett, Benedict, K, Bos, J, Bennett, SD, Lo, YC, Adebanjo, T et al. Necrotizing cutaneous mucormycosis after a tornado in Joplin, Missouri, in 2011. New Engl J Med 2012;367:2214–25CrossRefGoogle Scholar
Al-Otaibi, F, Albloushi, M, Alhindi, H, Timms, MS. Carotid artery occlusion by rhinoorbitocerebral mucormycosis. Case Rep Surg 2012;2012:812420Google ScholarPubMed
Song, YM, Shin, SY. Bilateral ophthalmic artery occlusion in rhino-orbito-cerebral mucormycosis. Korean J Ophthalmol 2008;22:66–9CrossRefGoogle ScholarPubMed
Anand, VK, Alemar, G, Griswold, JA. Intracranial complications of mucormycosis: an experimental model and clinical review. Laryngoscope 1992;102:656–62CrossRefGoogle ScholarPubMed
Scharf, EL, Cloft, HJ, Wijdicks, E. Mucor thrombus. Neurocrit Care 2016;24:268–72CrossRefGoogle ScholarPubMed
Lim, MA, Pranata, R. The danger of sedentary lifestyle in diabetic and obese people during the Covid-19 pandemic. Clin Med Insights Endocrinol Diabetes 2020;13:1179551420964487CrossRefGoogle ScholarPubMed
Bianconi, V, Violi, F, Fallarino, F, Pignatelli, P, Sahebkar, A, Pirro, M. Is acetylsalicylic acid a safe and potentially useful choice for adult patients with Covid-19? Drugs 2020;80:1383–96CrossRefGoogle ScholarPubMed
Mohamed-Hussein AAR, Aly KME, Ibrahim M-EAA. Should aspirin be used for prophylaxis of Covid-19-induced coagulopathy? Med Hypoth 2020;144:109975CrossRefGoogle Scholar
Middleton, EA, Weyrich, AS, Zimmerman, GA. Platelets in pulmonary immune responses and inflammatory lung diseases. Physiolog Rev 2016;96:1211–59CrossRefGoogle ScholarPubMed
Pranata, R, Huang, I, Lim, MA, Wahjoepramono, EJ, July, J. Impact of cerebrovascular and cardiovascular diseases on mortality and severity of Covid-19–systematic review, meta-analysis, and meta-regression. J Stroke Cerebrovasc Dis 2020;29:104949CrossRefGoogle ScholarPubMed
Martha, JW, Pranata, R, Lim, MA, Wibowo, A, Akbar, MR. Active prescription of low-dose aspirin during or prior to hospitalization and mortality in Covid-19: a systematic review and meta-analysis of adjusted effect estimates. Internat J Infect Dis 2021;108:612CrossRefGoogle ScholarPubMed
Gillespie, MB, O'Malley, BW. An algorithmic approach to the diagnosis and management of invasive fungal rhinosinusitis in the immunocompromised patient. Otolaryngologic Clin North Amer 2000;33:323–34CrossRefGoogle Scholar
Giannoudis, PV, Dinopoulos, H, Chlidis, B, Hall, GM. Surgical stress response. Injury 2006;37:S39CrossRefGoogle ScholarPubMed
Kaur, S, Bansal, R, Kollimuttathuillam, S, Gowda, AM, Singh, B, Mehta, D et al. The looming storm: blood and cytokines in Covid-19. Blood Rev 2021;46:100743CrossRefGoogle ScholarPubMed