A Prospective Study of COVID-19 Associated Mucormycosis at Tertiary Care Hospital

Abstract

Introduction: Mucormycosis is an emerging aggressive angioinvasive fungal infection due to non-septate fungi which belongs to order Mucorales. It is associated with covid-19 patients mainly with risk factors like diabetes mellitus use of steroids etc. Materials and Methods: The present study was carried out in 30 cases with a history of covid-19 infections and had acquired mucormycosis after recovery from SARS CoV-2 infection. These patients with history of mucormycosis were studied prospectively concerning the site involved, associated disease, evolution and diagnosis, therapy, and end result of the disease. Diagnosis was confirmed by histopatholgy with broad non-septate hyphae, ribbon-like with 90 degree-angled branching showing in specimen of tissue submitted. Result: Out of 30, 22 patients with maxillary sinusitis, seven cases of rhino-orbital mucormycosis, and one case with the rhino-orbital-cerebral mucormycosis. Twenty-five (83.3%) were males and mean age was 51 years. 25(83.3%) cases had diabetes Mellitus. HbA1C ranges from 5.4-10.9 and mean were 8.3. Out of 25 patients of diabetes mallitus, 16(64%) had uncontrolled Diabetes Mellitus on admission. Four (4/25, 16%) patients had Diabetes Mellitus of new onset. Out of the sixteen cases of uncontrolled Diabetes Mellitus 9(30%) had diabetic ketoacidosis. Out of 30 cases, 6 patients had no risk factors except steroids given as a part of therapy for covid-19 infection.Amid of 30 cases with COVID-19 eighteen (18/30,60 %) patients had severe COVID-19 disease, required ICU mechanical ventilation. 9(30%) had CKD out of which8(26.6%) cases. Mucormycosis were identified in all 30(100%) patients on H&E, PAS, and GMS. Conclusion: Mucormycosis is an aggressive angioinvasive disease with high morbidity and mortality. The disease has risen drastically in the recent times due to COVID 19 pandemic together with diabetes, inappropriate corticosteroid use and immunosuppression due to mechanical ventilation, prolonged hospitalization setting the perfect stormfor mucormycosis.