Scenario of mucormycosis in COVID-19 pandemic era from a tertiary care center in West Bengal

Abstract

Background: Coronavirus disease 2019 (COVID-19) is known to be associated with a myriad of viral, fungal, and bacterial co-infections. Rhino-orbital mucormycosis is a rare but deadly angio-invasive fungal infection which has shown a rising trend in the setting of COVID-19. Aims and Objectives: (1) To promptly diagnose mucormycosis using histopathological and microbiological examination. (2) To identify the possible risk factors for rhino-orbito-cerebral mucormycosis (ROCM). Materials and Methods: We present the histopathological and microbiological findings of 20 cases of mucormycosis, with a history of COVID-19 infection, with varying involvement of the nasal cavity, paranasal sinuses, and orbit. We received biopsy specimens and found black pigmentation underlying bone and took representative sections for histopathological examination. Results: We found profuse overwhelming growth of broad pauciseptate hyphae embedded in necrotic and inflammatory tissue in all cases. The etiological agent was diagnosed by histopathological examination and confirmed by growth in Sabouraud’s dextrose media (SDA) and lactophenol cotton blue (LPCB) mount revealed it as Rhizopus spp. and Rhizomucor spp. Data showed that Mucorales were detected predominantly in patients who had diabetes mellitus (DM) as initial presentation and it was detected in 15 of 20 patients (75%), mostly as pre-existing DM (93%) with one case of newly diagnosed DM (6%). Conclusion: ROCM is the most common and fulminating type of mucormycosis which is most commonly associated with DM as per our study, and if left untreated, may lead to fatal consequences, especially when an obvious underlying predisposing factor like diabetes or glucocorticoid therapy exists in a particular clinical setting. Hence, a prompt histopathological diagnosis and treatment are essential.