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Definition, diagnosis, and management of COVID-19-associated pulmonary mucormycosis: Delphi consensus statement.
Valliappan Muthu DM, Prof Ritesh Agarwal DM, Atul Patel MD, Soundappan Kathirvel MD, Prof Ooriapadickal Cherian Abraham MD, Prof Ashutosh Nath Aggarwal DM, Prof Amanjit Bal MD, Prof Ashu Seith Bhalla MD , Prashant N Chhajed MD k, Prof Dhruva Chaudhry DM l, Prof Mandeep Garg MD d, Randeep Guleria DM j, Ram Gopal Krishnan MD m, Prof Arvind Kumar MS o, Prof Uma Maheshwari DM p, Ravindra Mehta MD q, Prof Anant Mohan MD j, Prof Alok Nath DM r, Dharmesh Patel MD s, Prof Shivaprakash Mandya Rudramurthy MD e…Prof Arunaloke Chakrabarti MD e Abstract
COVID-19-associated pulmonary mucormycosis (CAPM) remains an underdiagnosed entity. Using a modified Delphi method, we have formulated a consensus statement for the diagnosis and management of CAPM. We selected 26 experts from various disciplines who are involved in managing CAPM. Three rounds of the Delphi process were held to reach consensus (≥70% agreement or disagreement) or dissensus. A consensus was achieved for 84 of the 89 statements. Pulmonary mucormycosis occurring within 3 months of COVID-19 diagnosis was labelled CAPM and classified further as proven, probable, and possible. We recommend flexible bronchoscopy to enable early diagnosis. The experts proposed definitions to categorise dual infections with aspergillosis and mucormycosis in patients with COVID-19. We recommend liposomal amphotericin B (5 mg/kg per day) and early surgery as central to the management of mucormycosis in patients with COVID-19. We recommend response assessment at 4-6 weeks using clinical and imaging parameters. Posaconazole or isavuconazole was recommended as maintenance therapy following initial response, but no consensus was reached for the duration of treatment. In patients with stable or progressive disease, the experts recommended salvage therapy with posaconazole or isavuconazole. CAPM is a rare but under-reported complication of COVID-19. Although we have proposed recommendations for defining, diagnosing, and managing CAPM, more extensive research is required.
