A critical appraisal of mucormycosis in COVID- ۱۹ patients in a tertiary care centre in India

Background and Purpose: Morbidity and mortality of opportunistic fungal infections in COVID-۱۹ patients are less studied and defined. The patients receiving immunosuppressive therapy, broad-spectrum antibiotics, corticosteroids, and invasive and non-invasive ventilation are the high-risk groups.Materials and Methods: The demographic profile as well as clinical and radiological findings of all the patients with COVID-۱۹ suspected of Mucormycosis (MM) were recorded. The tissue samples from all the patients were sent for microbiological (KOH mount and culture) and histopathological analysis for confirmation of MM.Results: In total, ۴۵ COVID-۱۹ patients suspected of MM were included in the study an MM was confirmed in ۴۲ patients. The mean age of the patients was ۵۰.۳۰±۱۴.۱۷ years with a female: male ratio of ۱.۱:۱. The most common symptom was headache (۵۲.۳۸%) followed by purulent nasal discharge (۳۸.۰۹%) and facial pain in ۳۳.۳۳% of the cases. The ocular symptoms included a diminution of vision (۳۳.۳۳%) and redness of the eye (۲.۳۸%).The most common site of involvement was rhino-orbital (۴۲.۸۵%) followed by sinonasal (۲۳.۸۰%) and rhino cerebral (۱۹.۰۴%). Majority (۳۸.۰۹%) of the patients were diagnosed with stage II of Rhino-orbital-cerebral Mucormycosis (ROCM) based on radiology. A history of diabetes mellitus and steroids was present in ۹۷.۶۱% and ۸۵.۷۱% of the cases, respectively. Moreover, KOH was positive for MM in ۹۷.۶۱% of the cases while the culture was positive in only ۳۵.۷۱% of the cases. In addition, on histopathology, MM was confirmed in ۶۴.۲۸ % of the cases. Mixed growth with Aspergillus species and Rhizopus species was observed in ۱۴.۲۸% of the cases in culture and ۱۱.۹۰% of the cases in histopathology test. Furthermore, angioinvasion was found in ۲۳.۸۰% of the cases according to the histopathology test.Conclusion: Based on the results, the most common conditions associated with MM in COVID-۱۹ patients were diabetes mellitus and steroid therapy. A high level of clinical suspicion aided with diagnostic tests, including KOH mount, culture, histopathology, and radiology which helped the early detection of opportunistic fungal infection in COVID-۱۹ patients to ensure timely treatment.

Keywords:

Aspergillosis , COVID-۱۹ , India , Mucormycosis