978. Disease Associations and Outcomes in Hospitalized Patients with Non-Cutaneous Mucormycosis: Data from the National Inpatient Sample

Background Data regarding comorbidities and hospital outcomes among patients with non-cutaneous mucormycosis is primarily derived from case reports and single institution series. This study was undertaken to define the prevalence of this condition among adult inpatients in the United States and to measure the frequency of comorbid illnesses and outcomes of inpatients with mucormycosis. Methods The 2016 National Inpatient Sample was used to identify a cohort of patients with a hospital diagnosis of non-cutaneous mucormycosis. Patients with mucormycosis and comorbid medical illnesses were identified by ICD-10 codes. The impact of disease site and comorbid illness on inpatient mortality was measured. Results A cohort of 95 adults with non-cutaneous mucormycosis was identified and included patients with pulmonary (n=53), rhinocerbral (n=25), disseminated (n=17), and gastrointestinal (n=4) mucormycosis. The prevalence of non-cutaneous mucormycosis was 15.7 cases per million admissions. Frequently associated medical conditions included diabetes mellitus (45.3%), hematologic malignancy (34.7%), hematopoietic stem cell transplant (6.3%), long term use of systemic steroids (6.3%), myelodysplastic syndrome (6.3%), solid organ transplant (5.3%), non-hematologic malignancy (4.2%), and iron overload disorders (2.1%). The median age of adults hospitalized with non-cutaneous mucormycosis was 53.2 years (range 18-83); patients were predominantly male (78.9%) and Caucasian (51.8%). The median length of stay for this cohort was 20 days (range 1-190) with a median total hospital cost of &323, 470 (range &2,401-&1,958,259) and an in-hospital mortality rate of 20%. The inpatient mortality rate was increased with underlying myelodysplastic syndrome (p=0.003) but not by other associated medical conditions or by site of disease. Conclusion Non-cutaneous mucormycosis is associated with a high in-hospital mortality rate and should be considered in patients with suggestive clinical presentations and underlying diabetes or conditions associated immunosuppression. Prompt recognition and tissue confirmation of this diagnosis leading to early surgical intervention and systemic antifungal therapy may improve outcomes. Disclosures All Authors: No reported disclosures

Extensive post-covid mucormycosis salvaged by old fashioned negative pressure wound therapy

Mucormycosis represents a group of life threatenening infections caused by fungi of the order Mucorales. Mucorales are ubiquitous environmental fungi that grow well in moist and damp conditions. They can invade arteries to cause thrombosis and infarction. These fungi cause infection primarily in patients with diabetes, neutropenia, elevated levels of free iron and those who are on glucocorticoid therapy, which supports fungal growth in serum and tissues. Recently the incidence of mucormycosis was found to have increased in patients previously infected with coronavirus (COVID-19). Here we presented a 52 year old lady who was previously infected by coronavirus, was administered glucocorticoids as a part of empirical treatment for COVID-19 pnemonitis. She recovered uneventfully within a few days, but, around a month later presented with erythematous papule over the anterior chest wall. The papule developed into a large fungating ulcer over a period of 10 days. KOH mount and culture confirmed it to be mucormycosis. Cutaneous mucormycosis can be highly invasive, penetrating into muscle, fascia and even bone. These are molds that grow well in moist and damp conditions. But depriving them of moisture and oxygen can help control their spread. This could be achieved by thorough debridement and applying negative pressure to the wound. The results achieved are remarkable and satisfactory.

Review of Published Case Reports of COVID-19 Associated Mucormycosis with Search of Therapeutic Potential in Ayurveda and Homeopathy

Background and Objectives: Infection with COVID-19 has been linked to fungal diseases. The sudden increase in mucormycosis cases has sparked the scientific community interest. In this review, we attempted to investigate the role of Ayurveda and Homoeopathy in the treatment of mucormycosis. Methodology: The research was carried out in three stages; first step, studies on COVID-19 and mucormycosis were searched on various databases such as PubMed and Google Scholar until May 21, 2021, second step was to search authentic Ayurvedic and Homeopathic text books for the context of mucormycosis and symptoms were repertorised to find homeopathic medicines and finally, in the last step, findings were analysed and concluded in order to arrive at a factual solution. Result: We found total 16 search results from bio-medical databases of which 14 articles were included. Except source books, no studies with respect to Ayurveda and Homoeopathy were found in above databases. In Ayurveda, Rajyakshama and krimijshirorog has close similarity to COVID associated mucormycosis. Vrinhana, vata-pitta nashakmadhuraushadhi, gritpaan,dugdha, nasya, dhum, kawal, gandush, mriduvirechan may be beneficial along with immune boosting drugs like ashawagandha, giloya, tulsi, vidanga etc. Rhino-orbito-cerbral mucormycosis (ROCM) can be treated with Arsenic album, Kali bichromicum, and Merc solubilis, while pulmonary mucormycosis (PM) with Arsenic album, Phosphorus and Acalypha indica. Similarly, gastrointestinal mucormycosis (GM) and cutaneous mucormycosis (CM) can be combated with Arsenic album, Lachesis, Merc Corrosivus etc. and Anthracinum, Arsenic album, Lachesis, Sulphur, Secale cornutum, and so on in Homoeopathy. Conclusion: In the absence of rigorous trials, the review results found no conclusive comment on the efficacy of CAM in mucormycosis, but anecdotal evidence suggests in favour. To demonstrate its role, rigorous, exploratory, pilot, randomised control trials should be conducted in the future, either alone or as an add-on. Key words: COVID-19; Mucormycosis; Black Fungus; Post-COVID-19 care; Rehabilitation; Ayurveda; Homoeopathy.

Cutaneous Mucormycosis of the Interscapular Region in an Immunocompetent Patient

Mucormycosis is an invasive fungal infection caused by opportunistic fungi of the phylum Glomeromycotan, subphylum Mucormycotina, mainly affecting individuals with immunosuppression. Cutaneous mucormycosis is the third most common clinical form of the disease preceded by pulmonary and rhinocerebral mucormycosis. The usual factors predisposing to this infection are individuals who are immunocompromised with conditions like HIV, haematological malignancies, and diabetes mellitus, but a significant proportion of patients are immunocompetent. The agents of mucormycosis are abundantly present in nature and are transmitted to the skin by direct inoculation. It may be due to needle sticks, stings, and bites by animals, motor-vehicle accidents, natural disasters, and burn injuries. The clinical presentation is non-specific, but an indurated plaque that rapidly evolves to necrosis (eschar) is a common finding. The infection can invade locally, and also penetrate into the adjacent fat, muscle, fascia, and bone, or become disseminated. It is difficult to diagnose because of the non-specific presentation of mucormycosis. Biopsy and culture should be performed. Treatment consists of multidisciplinary management, including surgical debridement, use of antifungal drugs (amphotericin B and posaconazole), and reversal of underlying risk factors, when possible. Mortality rates are significant, ranging from 4% to 10% in localised mucormycosis infection, but are lower than the other forms of the disease. The authors present a case here of a 38-year-old immunocompetent male with cutaneous mucormycosis at the interscapular region.