MUCOR MYCOSIS AND OTHER FUNGAL INFECTIONS IN COVID-19 PATIENTS DURING SECOND WAVE OF PANDEMIC AT A TERTIARY CARE HOSPITAL

Bharathi M; Sirisha T; Usharani A

doi:10.22159/ajpcr.2023.v16i12.48496

Authors

Bharathi M Department of Microbiology, Government Medical College, Srikakulam, Andhra Pradesh, India. https://orcid.org/0000-0002-6803-7278
Sirisha T Department of Microbiology, Government Medical College, Srikakulam, Andhra Pradesh, India. https://orcid.org/0009-0001-9165-4477
Usharani A Department of Microbiology, Government Medical College, Srikakulam, Andhra Pradesh, India.

DOI:

https://doi.org/10.22159/ajpcr.2023.v16i12.48496

Keywords:

COVID-19 Pandemic, Opportunistic infections, COVID-19-associated Mucor mycosis, Diabetes mellitus, Steroid therapy

Abstract

Objectives: In India, there has been a sudden Surge in Mucor mycosis cases during second wave of COVID-19, made the Government of India declare it as a notifiable disease. In this background, we did a study to know the fungal etiology of the suspected Mucor mycosis cases and to know the positivity rate of Mucor mycosis in COVID-19 patients during the second wave of the COVID-19 pandemic.

Methods: In a retrospective study, we examined different samples from 112 Covid-19 positive, in-patients with suspected Mucor mycosis. A history of risk factors was taken. Potassium hydroxide (KOH) mount was done for all samples followed by culture on Sabouraud’s dextrose agar.

Results: 81.25% of total cases were from 31 to 60 years of age group. Diabetes mellitus, steroid therapy, and Intensive care unit admissions were the risk factors observed. Fungal filaments were observed in 37 samples in KOH mount (33%) and culture was positive in 45 samples (40.17%). Mixed infection was seen in two cases (4.44%). The most common fungus isolated was Mucor in 23 samples (48.93%) followed by Aspergillus in 7 cases (14.89%; Aspergillus niger in four cases, Aspergillus fumigatus in 2 cases and Aspergillus flavus in 1 case) and Candida spp in 6 cases (12.76%). Among mixed infections, Mucor and A. niger in one case and Candida and A. niger in another case were isolated. Rhyzopus, Syncephalastrum, Penicillium, and Fusarium were the other fungi isolated.

Conclusion: Mucorales were the most common species isolated (63.82%) followed by Aspergillus species. High suspicion and diagnosis of Mucor mycosis in Covid-19 patients is very important to initiate antifungal treatment, to reduce the mortality.

Downloads

Download data is not yet available.

References

Skiada A, Pavleas I, Drogari-Apiranthitou M. Epidemiology and diagnosis of mucormycosis: An update. J Fungi (Basel) 2020;6:265. doi: 10.3390/jof6040265

Raut A, Tien Huy N. Rising incidence of mucormycosis in patients with Covid-19: Another challenge for India amidst the second wave? Lancet Respir Med 2021;9:e77.

Hoenigl M, Seidel D, Carvalho A, Rudramurthy SM, Arestehfar A, Gangneux JP, et al. The emergence of Covid-19 associated mucormycosis: A review of cases from 18 countries. Lancet Microbe 2022;3:e543-52.

Sarkar S, Gokhale T, Choudhury SS, Deb AK. COVID-19 and orbital mucormycosis. Indian J Ophthalmol 2021;69:1002-4.

Girdhar D, Manocha E. A comprehensive review on the management of COVID-19-associated mucormycosis (CAM): The new basics. BioMed 2022;2:181-98. doi: 10.3390/biomed2020017

Yasmin F, Najeeb H, Naeem A, Dapke K, Phadke R, Asghar MS, et al. COVID-19 associated mucormycosis: A systematic review from diagnostic challenges to management. Diseases 2021;9:65. doi: 10.3390/diseases9040065

Hussain S, Riad A, Singh A, Klugarová J, Antony B, Banna H, et al. Global prevalence of COVID-19-associated mucormycosis (CAM): Living systematic review and meta-analysis. J Fungi (Basel) 2021;7:985. doi: 10.3390/jof7110985

Asdaq SM, Rajan A, Damodaran A, Kamath SR, Nair KS, Zachariah SM, et al. Identifying mucormycosis severity in Indian COVID-19 patients: A nano-based diagnosis and the necessity for critical therapeutic intervention. Antibiotics (Basel) 2021;10:1308. doi: 10.3390/antibiotics10111308

Kumar A, Verma M, Hakim A, Sharma S, Meena R, Bhansali S. Epidemiology of mucormycosis cases during the second wave of COVID-19 in a tertiary care institute in Western Rajasthan, India. Cureus 2022;14:e22973.

Ibrahim AS, Spellberg B, Walsh TJ, Kontoyiannis DP. Pathogenesis of mucormycosis. Clin Infect Dis 2012;54 Suppl 1:S16-22.

Sundaram N, Bhende T, Yashwant R, Jadhav S, Jain A. Mucormycosis in COVID-19 patients. Indian J Ophthalmol 2021;69:3728-33. doi: 10.4103/ijo.IJO_1316_21

Bhatia M. The rise of mucormycosis in Covid-19 patients in India. Expert Rev Anti Infect Ther 2022;20:137-8. doi: 10.1080/14787210.2021.1960822

Azhar A, Khan WH, Khan PA, Alhosain K, Owais M, Ahmad A. Mucormycosis and COVID-19 pandemic: Clinical and diagnostic approach. J Infect Public Health 2022;15:466-79.

Chander J. Textbook of Medical Mycology. 4th ed., Ch. 26. New Delhi: JP Brothers Publishers; 2018. p. 554-96.

Aranjani JM, Manuel A, Razack HI, Mathew ST. COVID-19-associated mucormycosis: Evidence-based critical review of an emerging infection burden during the pandemic’s second wave in India. PLoS Negl Trop Dis 2021;15:e0009921. doi: 10.1371/journal.pntd.0009921

Ghosh R, Roy D, Benito-Leon J. Mucormycosis in COVID-19: The Indian scenario. J Med Mycol 2022;32:101275.

Gupta DP, Gupta S, Shah CK, Sreevidya SR. Clinical study of surge of mucormycosis in COVID-19 pandemic: A tertiary care center study. Indian J Otolaryngol Head Neck Surg 2021;74 Suppl 2:3455-62.

Singh AK, Singh R, Joshi SR, Misra A. Mucormycosis in Covid-19: A systematic review of cases reported worldwide and in India. Diabetes Metab Syndr 2021;15:102146.

Kandasamy S, Muthuraju S, Vasugi A, Chandrasekar M, Murugan R, Inbasekaran P, et al. Clinicopathological study of mucormycosis in COVID-19 patients: Experience from a tertiary care center in South India. Cureus 2022;14:e23016. doi: 10.7759/cureus.23016

Samale AA, Rathod VS, More SR, Gujrathi AB. Mucormycosis: A rare but rising fungal infection in COVID-19 patients at tertiary care centre. Int J Res Med Sci 2021;9:2645-50. doi: 10.18203/2320-6012. ijrms20213401

Revannavar SM, Supriya PS, Samaga L, Vineeth VK. COVID-19 triggering mucormycosis in a susceptible patient: A new phenomenon in the developing world? BMJ Case Rep 2021;14:e241663. doi: 10.1136/bcr-2021-241663

Alekseyev K, Didenko L, Chaudhry B. Rhinocerebral mucormycosis and COVID-19 pneumonia. J Med Cases 2021;12:85-9.

Nagalli S, Kikkeri NS. Mucormycosis in COVID-19: A systematic review of literature. Infez Med 2021;29:504-12. doi: 10.53854/liim-2904-2

Tooley AA, Bradley EA, Woog JJ. Rhino-orbital-cerebral mucormycosis-another deadly complication of COVID-19 infection. JAMA Ophthalmol 2022;140:73-4.

Sahu M, Shah M, Mallela VR, Kola VR, Boorugu HK, Punjani AA, et al. COVID-19 associated multisystemic mucormycosis from India: A multicentric retrospective study on clinical profile, predisposing factors, cumulative mortality and factors affecting outcome. Infection 2023;51:407-16. doi: 10.1007/s15010-022-01891-y

Srivastava MV, Vishnu VY, Pandit AK. Mucormycosis epidemic and stroke in India during the COVID-19 pandemic. Stroke 2021;52:e622- 3. doi: 10.1161/STROKEAHA.121.036626

Arjmand P, Bahrami M, Mohammadie ZE, Taherynejad M, Khorasani NY, Mehrad-Majd H, et al. Mucormycosis in pre-COVID-19 and COVID-19 era: A study of prevalence, risk factors and clinical features. Laryngoscope Investig Otolaryngol 2022;7:1343-50.

Selarka L, Sharma S, Saini D, Sharma S, Sharma AK, Chan CY, et al. Mucormycosis and COVID-19: An epidemic within a pandemic in India. Mycoses 2021;64:1253-60.

Joshi S, Telang R, Tambe M, Havaldar R, Sane M, Shaikh A, et al. Outbreak of mucormycosis in Coronavirus disease patients, Pune, India. Emerg Infect Dis 2022;28:1-8.