P365 Upsurge of Mucormycosis in COVID-19—a retrospective study in a tertiary care hospital in Punjab
Authors: Mohan Sangeetha 
Published: September 2022

Abstract

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

Objectives
Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been linked to a variety of opportunistic bacterial and fungal infections. Mucorales have been reported as the main fungal pathogens to exist as co-infection with COVID-19. Factors that contribute to a higher incidence of Mucormycosis or Mucorales to germinate in COVID-19 patients are high glucose levels in their blood (diabetes, steroid-induced hyperglycemia), low oxygen content (hypoxia), high iron levels, and decreased phagocytic activity of neutrophils due to immunosuppression because of cytokine storm in SARS-CoV-2 infection. Mucormycosis is an angioinvasive disease caused by order Mucorales and genus Rhizopus, Mucor, Rhizomucor, Cunnighamella, and Lichthemia. The most common species amongst all is Rhizopus arrhizus which is responsible for 90% cases of Rhino-Orbital Cerebral form and accounts for 60% cases of mucormycosis cases in India.

Methods
A retrospective study was conducted at Christian Medical College and Hospital, Ludhiana from May 1, 2021 to February 28, 2022 for a duration of 10 months. Most of the samples obtained were necrotic bone/tissue or mucosa from the rhino-cerebral part. The obtained sample was inoculated on Sabouraud's Dextrose Agar (SDA) at 22°C as well as 37°C followed by 40% KOH examination. The tubes were routinely checked once in a week and Lactophenol Cotton Blue (LPCB) preparation was made from teasing the isolate once it becomes culture positive.

Results
Total 29 samples were smear-positive for broad, sparsely septate hyphae in KOH examination under the microscope. Out of those 29 cases, 18 (62.06%) patients were COVID-19 positive (either RTPCR positive, TrueNat PCR positive, or Rapid Antigen positive), 5 patients were COVID-19 negative and COVID-19 testing was not done in 6 patients. Out of 29 smear-positive cases, 17 (58.62%) were culture positive for Mucorales, 7 (24.13%) grew contaminants namely Aspergillus species (mainly Aspergillus flavus), Penicillium species, bacterial contamination, and 5 (17.24%) were culture negative. Amongst 17 cases of Mucorales, 9 (52.94%) were Rhizopus species, 6 (35.29%) were Mucor species and 2 (11.76%) were Rhizomucor species. Amongst the culture-positive cases for Mucorales, 13 (72.22%) cases were COVID-19 positive.

Conclusion
COVID-19 has thrown the entire globe into chaos, and there is still no specific cure for this viral illness. Patients are susceptible to secondary fungal infections such as Mucormycosis as a result of the infection, immunosuppression, previous comorbidities, and medicines. Mucormycosis infection is severe because of its rapid disease progression and angioinvasive nature. As a result, researchers and healthcare practitioners should take immediate steps to control this mucormycosis infection by understanding its impact and severity, particularly in COVID-19 patients. A multidisciplinary approach should involve quick diagnosis, antifungal therapy, any surgical consultation, and treatment that may help to reverse the underlying disease.