COVID 19 and fungal infection - A double disaster:a case series

The recent Coronavirus pandemic in 2019 [COVID-19] was associated with an increased risk of opportunistic fungal co-infection. This case series presents 5 autopsy-confirmed fungal co-infections identified in patients who died following COVID-19. Among the notable findings were Fusarium-associated fungal myocarditis and human infection with Hormographiella, an extremely rare pathogen found in COVID-19. To the best of our knowledge, the latter represents the first reported fungal co-infection with this pathogen in COVID-19. We also report the first postmortem diagnosis of invasive pulmonary mucormycosis in COVID-19 in Sri Lanka, confirmed with culture as Rhizopus spp. Postmortem examination, histopathological analysis and fungal culture revealed fungal infections that had not been suspected clinically or had been only partially characterized, and provided the microbiological and pathological evidence necessary for establishing the cause of death These findings highlight the medicolegal importance of thorough autopsy examination in severe COVID-19, especially in situations where opportunistic fungal infection may have contributed to death.