P338 Clinicopathologic analysis of COVID-19-associated mucormycosis-experience from a tertiary care center in north india
Authors: Sengupta Arupparna , Misra Sunayana , Dhawan Shashi , Badwal Sonia 
Published: September 2022

Abstract

Poster session 3, September 23, 2022, 12:30 PM - 1:30 PM

Objectives
Due to the coronavirus disease (COVID-19) pandemic, a rapid increase in the number of opportunistic fungal infections was observed worldwide. Cases of mucormycosis described in patients with COVID-19 have been termed as COVID-19-associated mucormycosis (CAM).
We aim to

Methods
The archives of the histopathology department were searched for RTPCR-positive COVID-19 patients with suspected CAM from a period of September 2020 to November 2021. Those cases with follow-up data, adequate material for histopathologic evaluation, and confirmed mucormycosis were included. The medical records of these patients (clinico-demographic details—age, gender, associated comorbidities, steroid therapy, duration of hospital stay) were retrieved. The outcome was defined as death/discharge at follow-up. After routine processing, serial hematoxylin-eosin-stained slides and special stains (Silver Methenamine and Periodic Acid Schiff) were examined for fungal morphology and tissue reaction.
The histopathological parameters were neutrophilic infiltrate, fungal load, necrosis, angioinvasion, neural invasion, optic nerve invasion, presence of granuloma, bone invasion, and mixed fungal infection.

Results
A total of 169 cases of CAM met the inclusion criteria. Most common site of involvement was sino-nasal (n = 139) followed by orbital (n = 14), pulmonary (n = 12), gastrointestinal tract, and kidney (n = 2, each).
Male predominance was noted (71%, n = 119) with a male: female ratio of 2.5: 1. The patient ages ranged from 19 to 84 years with higher incidence noted in patients above 50 years (49.1%, n = 82) age group. The mean age of the population was 52.8 years. The most common comorbidity was diabetes mellitus (n = 74, 44%) followed by hypertension (n = 16, 9%), hypothyroidism (n = 5, 2.9%), coronary heart disease (n = 3, 1.7%), and chronic kidney disease (n = 2, 1.04). Most common clinical presentation was headache followed by facial pain or swelling.
Corticosteroids were administered in 76% (n = 127) of the patients.
On histopathology evaluation, 123 cases showed angioinvasion, 30 cases showed perineural invasion and 8 cases showed intraneural invasion. Optic nerve invasion was present in 13 cases of which perineural and intraneural optic nerve invasion was seen in 5 cases. Mixed infection with Aspergillus species was noted in 4.1% (n = 7) cases, also confirmed by fungal culture. Radiological correlation to evaluate extent of bone invasion was done, wherever available. Of the 169 patients, 149 recovered due to timely surgical intervention and medical management while 20 succumbed due to multisystem involvement [mortality in sino-nasal and orbital involvement n = 17 (10%), lung n = 2 (1.1%), GIT n = 1 (0.5%)].

Conclusion
COVID-19 causes severe immune dysregulation leading to cytokine storm. An upsurge in CAM during the second wave of COVID-19 pandemic in India was seen in patients with additional co-morbidities; mainly uncontrolled diabetes and injudicious use of corticosteroids. Although mortality is high, timely intervention can prove to be life-saving as was seen in our series.