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Can histopathology predict survival in mucormycosis? A retrospective analysis
Shilpi Saxena1, Anubhav Singh2, Kamal Deep Joshi3
1Classified Specialist (Pathology) & Trained in Hemato-Pathology, Command Hospital (Western Command), Chandimandir, Panchkula, Haryana, India.
Background:
Mucormycosis is a rare infection, with incidence rising gradually over decades. However, during the COVID-19 pandemic, a blitzkrieg increase in cases was unprecedented. This phenomenon has remained unexplained, even though many theories have been postulated. Since the disease was rare previously, the implication of many clinical and pathological factors in its relation is still unclear and needs to be explored. This study was conducted with the aim to identify the clinico-histopathological factors associated with rhino-orbital mucormycosis (ROM) and to analyze their role in predicting survival.
Methods:
A retrospective analytical study was conducted in a tertiary healthcare center from April 2020 to March 2024 on 63 diagnosed cases of ROM. The various clinical factors (age, gender, comorbidities) and histopathological parameters (fungal load, predominant inflammation, grade of inflammation, tissue necrosis, presence of granuloma, angioinvasion, or perineural invasion) were evaluated for their significance in predicting survival.
Results:
The study showed a male preponderance and the commonest clinical comorbidity noted was diabetes mellitus. Clinically, the patients without orbital involvement had significantly greater survival. The evaluation of pathological parameters revealed that the cases with granuloma formation had better survival, while those with involvement of >2 cell types and lesser tissue necrosis had greater intervals between diagnosis and death.
Conclusion:
In patients with ROM, orbital involvement has a more sinister impact on survival. Various histopathological characteristics can predict prognosis and possibly aid as a guide for implementing more aggressive management plans to improve survival.
Insights
Rhino-orbital mucormycosis (ROM) survival is impacted by orbital involvement. Histopathological factors like granuloma presence and tissue necrosis can predict prognosis in these rare fungal infections.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Pathology
Background:
- Mucormycosis incidence has risen, with an unprecedented surge during the COVID-19 pandemic.
- The factors influencing rhino-orbital mucormycosis (ROM) remain unclear.
- Further exploration of clinico-histopathological factors is needed to understand ROM's impact.
Purpose of the Study:
- To identify clinico-histopathological factors associated with ROM.
- To analyze the role of these factors in predicting patient survival.
Main Methods:
- A retrospective analytical study of 63 ROM cases (April 2020-March 2024).
- Evaluation of clinical factors (age, gender, comorbidities) and histopathological parameters (fungal load, inflammation, necrosis, invasion).
Main Results:
- Male predominance observed; diabetes mellitus was the most common comorbidity.
- Absence of orbital involvement correlated with significantly greater survival.
- Granuloma formation indicated better survival; involvement of >2 cell types and lesser necrosis predicted longer survival intervals.
Conclusions:
- Orbital involvement in ROM significantly worsens survival.
- Histopathological characteristics can predict prognosis in ROM.
- These findings may guide more aggressive management strategies to improve survival.
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