Clinicopathological Study of Mucormycosis in Post Covid Patients, an Epidemic in Pandemic
Keywords:Mucormycosis, Prevalence, Post COVID patients, Diabetes Mellitus, Corticosteroids.
AbstractMucormycosis is an angio-invasive disease caused by saprophytic fungi of the order Mucorales. Mucormycosis has been established and recognized as a complication of the SARS-CoV-2 infection. Mucormycosis, well known as "black fungus" is creating an epidemic within a global pandemic. The use of different dose regimens, prominent steroids, and multiple comorbidities like Diabetes Mellitus and post-COVID could predispose to mucormycosis. The aim of the study was to study the increase in cases and morphological features of mucormycosis infection in hospitalized post-COVID patients. This prospective study was done for four months, from May 1st, 2021, to August 31st, 2021. All the suspected cases of mucormycosis specimens sent to the Department of Pathology, J.J.M. Medical College, Davangere, for histopathological diagnosis were considered. For microscopic examination, the collected samples were fixed in 10% formalin solution, processed, and stained with Haematoxylin and Eosin. Periodic Acid-Schiff special staining was done. Thirty cases of mucormycosis were collected from patients who had recovered from COVID-19. Mean age 63±12 (37-80) years with Male:Female ratio being 1.3:1. The mean duration between diagnosis of COVID-19 and development of symptoms of mucor was 23.5±10 (7–60) days. Rhino-orbital mucormycosis was the most typical presentation. Out of 30 cases, 28 cases (93.3%) were Type 2 Diabetes Mellitus, and 2 cases (6.6%)were nondiabetic. All patients received corticosteroids for the treatment of COVID-19. Trinity of COVID -19, Diabetes Mellitus, and Corticosteroid treatment was significant for the rise in mucormycosis cases. Mucormycosis is an invasive fungal infection and had seen a sudden surge during the second wave of COVID-19. In our study, most patients had a history of diabetes, and corticosteroid therapy with rhino-orbital mucormycosis was the most typical presentation. As the severity of the necrosis increases, the presence of fungal hyphae also increases, which leads to extensive destruction of tissue. Extra vigilance in immunosuppressed patients helps in reducing the morbidity and mortality due to mucormycosis in Post COVID era.
Chavda, V., & Apostolopoulos, V. (2021). Mucormycosis – An opportunistic infection in the aged immunocompromised individual: A reason for concern in COVID-19. Maturitas, 154, 58-61. doi: 10.1016/j.maturitas.2021.07.009
Čolović, N., Arsić-Arsenijević, V., Barać, A., Suvajdžić, N., Leković, D., & Tomin, D. (2016). Mucormycosis of the paranasal sinuses in a patient with acute myeloid leukemia. Srpski arhiv za celokupno lekarstvo, 144(11-12), 657–660.
Gangneux, J. P., Bougnoux, M. E., Dannaoui, E., Cornet, M., & Zahar, J. R. (2020). Invasive fungal diseases during COVID-19: We should be prepared. Journal de mycologie medicale, 30(2), 100971. https://doi.org/10.1016/j.mycmed.2020.100971.
Goel, A., Kini, U., & Shetty, S. (2010). Role of histopathology as an aid to prognosis in rhino-orbito-cerebral zygomycosis. Indian journal of pathology & microbiology, 53(2), 253–257. https://doi.org/10.4103/0377-4929.64342.
Karadeniz Uğurlu, Ş., Selim, S., Kopar, A., & Songu, M. (2015). Rhino-orbital Mucormycosis: Clinical Findings and Treatment Outcomes of Four Cases. Turkish journal of ophthalmology, 45(4), 169–174. https://doi.org/10.4274/tjo.82474.
Mehta, S., & Pandey, A. (2020). Rhino-Orbital Mucormycosis Associated With COVID-19. Cureus, 12(9), e10726. https://doi.org/10.7759/cureus.10726.
Papadogeorgakis, N., Parara, E., Petsinis, V., & Vourlakou, C. (2010). A case of successfully treated rhinocerebral mucormycosis: dental implications. International journal of dentistry, 2010, 273127. https://doi.org/10.1155/2010/273127.
Prakash, H., & Chakrabarti, A. (2021). Epidemiology of Mucormycosis in India. Microorganisms, 9(3), 523. https://doi.org/10.3390/microorganisms9030523.
Reid, G., Lynch, J. P., 3rd, Fishbein, M. C., & Clark, N. M. (2020). Mucormycosis. Seminars in respiratory and critical care medicine, 41(1), 99–114. https://doi.org/10.1055/s-0039-3401992
Sen, M., Lahane, S., Lahane, T. P., Parekh, R., & Honavar, S. G. (2021). Mucor in a Viral Land: A Tale of Two Pathogens. Indian journal of ophthalmology, 69(2), 244–252. https://doi.org/10.4103/ijo.IJO_3774_20.
Singh, A. K., Singh, R., Joshi, S. R., & Misra, A. (2021). Mucormycosis in COVID-19: A systematic review of cases reported worldwide and in India. Diabetes & metabolic syndrome, 15(4), 102146. https://doi.org/10.1016/j.dsx.2021.05.019
V Jagtap, S., S Jagtap, S., Nagar, V., & Varshney, K. (2021). Invasive mucormycosis in post COVID-19 infection: Case report with review. IP Archives Of Cytology And Histopathology Research, 6(2), 135-139. doi: 10.18231/j.achr.2021.033
Werthman-Ehrenreich A. (2021). Mucormycosis with orbital compartment syndrome in a patient with COVID-19. The American journal of emergency medicine, 42, 264.e5–264.e8. https://doi.org/10.1016/j.ajem.2020.09.032.
WHO. (2019). Available from: https://www.who.int/publications/i/item/WHO‑2019‑nCoV-Corticosteroids-2020 [Last accessed on 2020 Dec 17].
How to Cite
Publishing your paper with Medical Laboratory Technology Journal (MLTJ) means that the author or authors retain the copyright in the paper. MLTJ granted an author(s) rights to put the paper onto a website, distribute it to colleagues, give it to students, use it in your thesis etc, even commercially. The author(s) can reuse the figures and tables and other information contained in their paper published by MLTJ in future papers or work without having to ask anyone for permission, provided that the figures, tables or other information that is included in the new paper or work properly references the published paper as the source of the figures, tables or other information, and the new paper or work is not direct at private monetary gain or commercial advantage.
MLTJ journal provides immediate open access to its content on the principle that making research freely available to the public supports a greater global exchange of knowledge. This journal is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License. This license lets others remix, transform, and build upon the material for any purpose, even commercially. MLTJ journal Open Access articles are distributed under this Creative Commons Attribution-ShareAlike 4.0 International License (CC BY-SA). Articles can be read and shared for All purposes under the following conditions:
BY: You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.SA: If you remix, transform, or build upon the material, you must distribute your contributions under the same license as the original.