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The baneful alliance of COVID-19 and mucormycosis: Histopathological concerns
Anshu Singh1, Vijay Kumar1, Vikul Kumar2
1Department of Pathology, Lala Lajpat Rai Memorial Medical College, Meerut, Uttar Pradesh, India.
Background:
Mucormycosis, once a rare fungal disease, has now shown a surge in cases, and its epidemiology in India is intriguing. Rising incidence confers the necessity of defining the demography of the population at risk, early diagnosis, and recommendations for the management of mucormycosis in patients with coronavirus disease (COVID-19) infection.
Aims:
To study the clinico-epidemological profile, risk factors, and histopathological features of COVID-19-associated Mucormycosis (CAM).
Setting And Design:
This is a retrospective observational study.
Material And Methods:
Fifty-six biopsy specimens taken from patients of COVID-19 with clinical suspicion of mucormycosis were included.
Results:
Diabetes mellitus, corticosteroids, and oxygen therapy were the most common risk factors associated with CAM. The mean duration between the onset of symptoms of COVID-19 and onset of CAM was 25.2 ± 15.3 days. Rhino-orbito-cerebral mucormycosis (ROCM) was present in 24.5% of the cases, with a survival rate of 58.3%. Histopathology showed tissue invasion by branching broad-based, pale, fungal hyphae consistent with mucor in 49 (87.5%) cases. Inflammation was acute neutrophilic type in 61.2% of the patients with a survival rate of 63.33%. The survival rate with chronic non-granulomatous and chronic granulomatous was 100% and 81.8%, respectively.
Conclusion:
Keeping a high index of suspicion for mucormycosis in COVID-19 by all medical fraternities of the health community in the existence of risk factors is the need of the hour for prompt diagnosis. Biopsy of antral necrotic tissue should be performed immediately after suspicion for histopathological study to confirm the diagnosis of mucormycosis and predict prognosis depending on the type of inflammation incited, fungal morphology, load, and necrosis.
Insights
COVID-19-associated mucormycosis (CAM) is surging in India. Key risk factors include diabetes, corticosteroids, and oxygen therapy, necessitating prompt diagnosis through biopsy and histopathology for better prognosis.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Epidemiology
Background:
- Mucormycosis, a rare fungal infection, is experiencing a notable increase in cases.
- The epidemiology of mucormycosis in India, particularly in the context of COVID-19, requires urgent investigation.
- Rising incidence highlights the need to identify at-risk populations, improve early diagnosis, and establish management guidelines for COVID-19 patients.
Purpose of the Study:
- To investigate the clinical and epidemiological characteristics of COVID-19-associated mucormycosis (CAM).
- To identify significant risk factors contributing to the development of CAM.
- To analyze histopathological findings in CAM cases and correlate them with patient outcomes.
Main Methods:
- A retrospective observational study design was employed.
- Biopsy specimens from 56 patients with suspected mucormycosis and COVID-19 were analyzed.
- Histopathological examination focused on fungal morphology, tissue invasion, and inflammatory patterns.
Main Results:
- Diabetes mellitus, corticosteroid use, and oxygen therapy were identified as primary risk factors for CAM.
- The average time from COVID-19 symptom onset to CAM onset was 25.2 days.
- Histopathology confirmed mucormycosis in 87.5% of cases, with acute neutrophilic inflammation associated with a 63.33% survival rate.
Conclusions:
- A high index of suspicion for mucormycosis in COVID-19 patients with risk factors is crucial for timely diagnosis.
- Immediate biopsy of suspected necrotic tissue for histopathological study is recommended for diagnosis and prognosis.
- Prognosis is influenced by inflammation type, fungal characteristics, and tissue necrosis.
