Microbiological Genus Characterisation, Clinical Features, and Outcome in Patients of COVID-19 Associated Mucormycosis: A Single-centre Cross-sectional Study

Abstract

Introduction: Mucormycosis is a known invasive fungal infection, its prevalence increased during the Coronavirus Disease-2019 (COVID-19) pandemic, particularly during the second wave. The most common clinical form is rhino-orbitalcerebral, but other forms such as pulmonary, gastrointestinal, cutaneous, and disseminated forms also exist. There have been very few Indian studies exploring the various aspects of COVID19 Associated Mucormycosis (CAM). Aim: To describe and characterise the genus of the causative agents of mucormycosis, an invasive fungal infection, and to analyse the clinical features and outcomes in the study participants. Materials and Methods: This was a cross-sectional study conducted in a dedicated COVID-19 Care Hospital at Dr. Vasantrao Pawar Medical College in Nashik City, Maharashtra, India. The study duration was one year, from February 2021 to January 2022. The universal sampling strategy included all clinically diagnosed cases of mucormycosis (n=104). The study variables included demographic factors, presence of risk factors, organ involvement, and in-hospital mortality. Diagnosis was based on fungal Potassium Hydroxide (KOH) mount and fungal culture. Genus characterisation was performed using Lactophenol Cotton Blue (LPCB) mount. Data were analysed using Statistical Package for the Social Sciences (SPSS) version 16.0, and the Chi-square test was applied to study the association between qualitative variables. Results: The majority of patients with the disease were male (77, 74%). The most commonly involved site was isolated paranasal sinuses (48, 46.1%), followed by paranasal sinus with maxilla involvement (24, 23.1%). The KOH report was positive in 100 (96.2%) of patients. Fungal growth in culture was reported in 69 (66.3%) patients, among them Rhizopus spp. (66, 95.6%) being the most common fungal genus isolated. Among 25 patients in the age category >60 years, 21 (84%) had a positive culture (p-value=0.041, significant). Diabetic patients had a significantly higher incidence of mucormycosis compared to non diabetics based on culture results (p-value=0.004). The mortality rate in this study was 26 (25%). Conclusion: Mucormycosis was more prevalent in males and predominantly affected the paranasal sinuses. Risk factors such as age category, sex, and a history of diabetes were significantly associated with the presence of mucormycosis. KOH can be used as a quick diagnostic test to initiate prompt treatment.