Study on Covid-19 Associated Mucormycosis in Patients Attending a Tertiary Care Hospital During Pandemic in India

Background: The Corona virus (Covid-19) infection is one of the cause for immunosuppressed state and increased risk for secondary infections. The Delta variant (B.1.617.2) was the most common variant circulating at that time. We have evaluated clinical features, predisposing factors, diagnosis and outcomes for mucormycosis among patients with Covid-19 infection. Mucormycosis is an opportunistic and angioinvasive fungal infection caused by the Mucorales family with Rhizopus and Mucor. It has the high morbidity and Mortality that requires prompt recognition and immediate intervention. The most important risk factors are uncontrolled blood sugar, the use of corticosteroids, and immune dysfunction due to Covid-19 infection. Poor glycaemic control is the single most cause for worse outcomes despite aggressive medical and surgical interventions. Aim & Objectives: To study the association between covid-19 and Mucormycosis in patients attending at Tertiary care centre during pandemic attack. Materials & Methods: This prospective observational study was conducted from May 2021 to October 2021.A total of 77 Covid-19positive patients with signs and symptoms suggestive of Mucormycosis were included in this study attending at Department of Microbiology in association with Department of Oto Rhino laryngology (ENT), Government Tiruvannamalai Medical College and Research Institute, Tiruvannamalai. As per the Standard aseptic precautions, Biopsy tissue samples were collected during FESS (Functional Endoscopic Sinus Surgery) from clinically and radiologically suspected cases of mucormycosis with Covid-19 infection after getting informed consent. All the samples were processed for Mycology culture isolation. The isolates examined under 10% KOH for detection of fungal elements and inoculated into Sabouraud’s Dextrose Agar (SDA) and kept in Biological Oxygen Demand (BOD) for 2-4 weeks. The results were analysed in correlation with the clinical details and cultural growth identification. The cultural isolates were then subjected to LPCB (Lacto Phenol Cotton Blue) for Mucorales confirmation. Results: A total of 35 (45.4%) were positive for presence of fungal elements in either KOH mount or fungal growth on SDA. Gram positive budding yeast cells (ie) Candida species were most commonly isolated in culture, followed by Rhizopus spp, Aspergillus spp and Mucor spp. Mucormycosis was predominantly seen in males, 8 (10.38%), then in females 2 (2.6%). The commonest risk factors associated with mucormycosis were Covid-19 positivity and Diabetes mellitus (poor Glycaemic control). Conclusion: Mucormycosis can occur among Covid-19 patients, especially with poor glycaemic control, widespread and injudicious use of corticosteroids and broad-spectrum antibiotics, and invasive ventilation, owing to the high mortality. High index of suspicion is required to ensure timely diagnosis and appropriate treatment in high- risk populations to avoid mortality and reduce the complications of Mucormycosis.