Mixed Invasive Fungal Infections Among Covid-19 Patients

Background and purpose: the healthcare system in india collapsed during the second wave of the covid-19 pandemic. a fungal epidemic was announced amid the pandemic with several cases of covid-associated mucormycosis and pulmonary aspergillosis being reported. however, there is limited data regarding mixed fungal infections in covid-19 patients. therefore, we present a series of ten consecutive covid-19 patients with mixed invasive fungal infections (mifis). materials and methods: among covid-19 patients hospitalized in may 2021 at a tertiary care center in north india, 10 cases of microbiologically confirmed covid-19-associated mucormycosis-aspergillosis (cama) were evaluated. results: all patients had diabetes and the majority of them were infected with severe covid-19 pneumonia (6/10, 60%) either on admission or in the past month while two were each of moderate (20%) and mild (20%) categories of covid-19; and were treated with steroid and cocktail therapy. the patients were managed with amphotericin-b along with surgical intervention. in total, 70% of all cama patients (rhizopus arrhizus with aspergillus flavus in seven and aspergillus fumigatus complex in three patients) survived. conclusion: the study findings reflected the critical importance of a high index of clinical suspicion and accurate microbiological diagnosis in managing invasive dual molds and better understanding of the risk and progression of mifis among covid-19 patients. careful scrutiny and identification of mifis play a key role in the implementation of effective management strategies.