{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T01:42:04Z","timestamp":1792114924690,"version":"4.4.0"},"reference-count":29,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2023,2,27]],"date-time":"2023-02-27T00:00:00Z","timestamp":1677456000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Mycoses"],"published-print":{"date-parts":[[2023,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The aetiology of the major outbreak of COVID\u201019\u2010associated mucormycosis (CAM) in India in spring 2021 remains incompletely understood. Herein, we provide a multifaceted and multi\u2010institutional analysis of clinical, pathogen\u2010related, environmental and healthcare\u2010related factors during CAM outbreak in the metropolitan New Delhi area.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We reviewed medical records of all patients diagnosed with biopsy\u2010proven CAM (<jats:italic>n<\/jats:italic>\u00a0=\u00a050) at 7 hospitals in the New Delhi, and NCR area in April\u2013June 2021. Two multivariate logistic regression models were used to compare clinical characteristics of CAM cases with COVID\u201019\u2010hospitalised contemporary patients as controls (<jats:italic>n<\/jats:italic>\u00a0=\u00a069). Additionally, meteorological parameters and mould spore concentrations in outdoor air were analysed. Selected hospital fomites were cultured. Mucorales isolates from CAM patients were analysed by ITS sequencing and whole\u2010genome sequencing (WGS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Independent risk factors for CAM identified by multivariate analysis were previously or newly diagnosed diabetes mellitus, active cancer and severe COVID\u201019 infection. Supplemental oxygen, remdesivir therapy and ICU admission for COVID\u201019 were associated with reduced CAM risk. The CAM incidence peak was preceded by an uptick in environmental spore concentrations in the preceding 3\u20134\u2009weeks that correlated with increasing temperature, high evaporation and decreasing relative humidity. <jats:italic>Rhizopus<\/jats:italic> was the most common genus isolated, but we also identified two cases of the uncommon Mucorales, <jats:italic>Lichtheimia ornata<\/jats:italic>. WGS found no clonal population of patient isolates. No Mucorales were cultured from hospital fomites.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>An intersection of host and environmental factors contributed to the emergence of CAM. Surrogates of access to advanced COVID\u201019 treatment were associated with lower CAM risk.<\/jats:p><\/jats:sec>","DOI":"10.1111\/myc.13578","type":"journal-article","created":{"date-parts":[[2023,2,15]],"date-time":"2023-02-15T13:13:51Z","timestamp":1676466831000},"page":"515-526","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Multimodal analysis of the <scp>COVID<\/scp>\u201019\u2010associated mucormycosis outbreak in Delhi, India indicates the convergence of clinical and environmental risk factors"],"prefix":"10.1111","volume":"66","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2028-7462","authenticated-orcid":false,"given":"Anuradha","family":"Chowdhary","sequence":"first","affiliation":[{"name":"Medical Mycology Unit, Department of Microbiology Vallabhbhai Patel Chest Institute, University of Delhi  New Delhi India"},{"name":"National Reference Laboratory for Antimicrobial Resistance in Fungal Pathogens Vallabhbhai Patel Chest Institute, University of Delhi  New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5842-5584","authenticated-orcid":false,"given":"Nitesh","family":"Gupta","sequence":"additional","affiliation":[{"name":"Pulmonary Medicine, Safdarjung Hospital Vardhman Mahavir Medical College  New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Wurster","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Infection Control and Employee Health The University of Texas MD Anderson Cancer Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raj","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, National Centre of Respiratory Allergy Asthma and Immunology Vallabhbhai Patel Chest Institute, University of Delhi  New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5300-9824","authenticated-orcid":false,"given":"Jason T.","family":"Mohabir","sequence":"additional","affiliation":[{"name":"Infectious Disease and Microbiome Program Broad Institute of MIT and Harvard  Cambridge Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shashidhar","family":"Tatavarthy","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Artemis Hospital  Gurugram India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vikas","family":"Mittal","sequence":"additional","affiliation":[{"name":"Pulmonary Medicine Max Super Specialty Hospital  New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Preeti","family":"Rani","sequence":"additional","affiliation":[{"name":"Medical Mycology Unit, Department of Microbiology Vallabhbhai Patel Chest Institute, University of Delhi  New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Purabi","family":"Barman","sequence":"additional","affiliation":[{"name":"BLK\u2010Max Super Speciality Hospital  New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neelam","family":"Sachdeva","sequence":"additional","affiliation":[{"name":"Department of Microbiology Rajiv Gandhi Cancer Institute &amp; Research Center  New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashutosh","family":"Singh","sequence":"additional","affiliation":[{"name":"Medical Mycology Unit, Department of Microbiology Vallabhbhai Patel Chest Institute, University of Delhi  New Delhi India"},{"name":"National Reference Laboratory for Antimicrobial Resistance in Fungal Pathogens Vallabhbhai Patel Chest Institute, University of Delhi  New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brijesh","family":"Sharma","sequence":"additional","affiliation":[{"name":"Department of Medicine Ram Manohar Lohia Hospital &amp; Postgraduate Institute of Medical Education and Research  New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Infection Control and Employee Health The University of Texas MD Anderson Cancer Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5778-960X","authenticated-orcid":false,"given":"Christina A.","family":"Cuomo","sequence":"additional","affiliation":[{"name":"Infectious Disease and Microbiome Program Broad Institute of MIT and Harvard  Cambridge Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8051-2940","authenticated-orcid":false,"given":"Dimitrios P.","family":"Kontoyiannis","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Infection Control and Employee Health The University of Texas MD Anderson Cancer Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,2,27]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/myc.13353"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11046-021-00528-2"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.3389\/fcimb.2022.937481"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.3201\/eid2901.220926"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jinf.2021.12.039"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/civ1006"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.4103\/0972-6691.162980"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.4103\/ijaai.ijaai_35_17"},{"key":"e_1_2_9_10_1","unstructured":"Observational Data Repository.Indian Agricultural Research Institute New Delhi India.https:\/\/krishi.icar.gov.in\/ObservationData\/home\/iari. 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