A Critical Appraisal of Mucormycosis in Covid- 19 Patients in A Tertiary Care Centre in India

Background and purpose: morbidity and mortality of opportunistic fungal infections in covid-19 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-19 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, 45 covid-19 patients suspected of mm were included in the study an mm was confirmed in 42 patients. the mean age of the patients was 50.30±14.17 years with a female: male ratio of 1.1:1. the most common symptom was headache (52.38%) followed by purulent nasal discharge (38.09%) and facial pain in 33.33% of the cases. the ocular symptoms included a diminution of vision (33.33%) and redness of the eye (2.38%).the most common site of involvement was rhino-orbital (42.85%) followed by sinonasal (23.80%) and rhino cerebral (19.04%). majority (38.09%) 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 97.61% and 85.71% of the cases, respectively. moreover, koh was positive for mm in 97.61% of the cases while the culture was positive in only 35.71% of the cases. in addition, on histopathology, mm was confirmed in 64.28 % of the cases. mixed growth with aspergillus species and rhizopus species was observed in 14.28% of the cases in culture and 11.90% of the cases in histopathology test. furthermore, angioinvasion was found in 23.80% of the cases according to the histopathology test.conclusion: based on the results, the most common conditions associated with mm in covid-19 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-19 patients to ensure timely treatment.