Study Correlating Neutrophil-Lymphocyte Ratio with Clinical Staging in Mucormycosis Patients

Rhino-orbital mucormycosis is an aggressive fungal opportunistic infection of the immune-compromised, debilitated patients. The presence of neutrophilia and lymphocytopenia in patients affected with mucormycosis have been reported. Not much study has been done to establish the ratio of neutrophil to lymphocyte as a possible indicator for the severity of Rhino-orbital mucormycosis which is clinical staged. As such, this study aims to find out the relationship of the neutrophil-lymphocyte ratio with the clinical staging of Rhino-orbital mucormycosis in COVID19 recovered patient and if such a ratio can help to identify the severity of the opportunistic fungal infection.

This is a Cross-sectional study done on 100 patients who were diagnosed with Mucormycosis based on radiological findings, post-COVID19 recovery. The neutrophil-lymphocyte ratio was estimated after obtaining the complete blood count of the patient and calculating the ratio by the division of differential Neutrophil by the differential Lymphocyte count. The clinical staging of Mucormycosis was done based on radiological findings.

The median value of Neutrophil Lymphocyte ratio was found to be elevated in all the clinical stages of Mucormycosis (from stage 2 to 4) at the time of admission as well as discharge considering the normal value of N/L ratio in a healthy individual to be 3. The median N/L ratio was also found to be in decreasing trend as compared from the time of admission to discharge in all the stages 2 to 4 of mucormycosis and was statistically significant (p=0.00) in stage 3 of mucormycosis.

The Neutrophil-Lymphocyte ratio can be used as a viable marker of severity of mucormycosis and is a good prognostic indicator for resolution of disease especially in stage 3 of mucormycosis. This study helps to reiterate the importance of N/L ratio in the treatment protocol of mucormycosis.