Histopathological Study of Mucormycosis in Post COVID-19 Patients and Factors Affecting it in a Tertiary Care Hospital

Abstract

Introduction. COVID-19 is an infection caused by severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) which may be associated with a wide range of bacterial and fungal co-infections. Mucormycosis is an opportunistic fungal infection occurring in post COVID-19 patients. Objectives. To study the role of histopathology in mucormycosis and the predisposing factors associated in development of mucormycosis in post COVID-19 patients. Materials and methods. A prospective observational study was conducted in our hospital in the pathology department over a period of 3 months on 200 patients with mucormycosis who were infected with SARS-CoV-2 virus. Results. Out of the 200 patients with mucormycosis studied in post COVID-19 patients, age ranged from 21–80 years, of which 132 were men and 68 were women. Sites involved by mucormycosis were sinuses, orbit, cranium, and cutaneous. Ethmoid sinus was most involved, followed by maxillary sinus. Diabetes was present in 162 patients and hypertension in 92 patients. On histopathological examination, fungal load was severe in 49 patients, angioinvasion was present in 48 patients, perineural invasion was present in 32 patients, and necrosis was present in 121 patients. The number of patients discharged after surgery was 169, whereas 31 died. Conclusion. Histopathological features of mucormycosis like angioinvasion, perineural invasion, severe fungal load, and large areas of necrosis were directly proportional to the mortality rate. Thus, histopathologists can help in assessing prognosis at the time of tissue diagnosis, so that clinicians can optimize treatment accordingly. Diabetes and history of corticosteroid intake for treatment of COVID-19 were the two commonest predisposing factors for development of mucormycosis.

Histopathological spectrum of fungal infections in COVID 19 cases – A retrospective observational study

“…4 On the basis of its anatomic location, mucormycosis can be classified as isolated nasal, rhino-orbital or rhinoorbital cerebral, pulmonary, gastrointestinal, cutaneous, disseminated and miscellaneous. 8 In a study by Shree Laxmi et al the age of patients ranged from 21 to 80 years with a male preponderance; similar demographic details were noted in the present study. 8 The maxillary sinus was the most common affected site.…”

“…8 In a study by Shree Laxmi et al the age of patients ranged from 21 to 80 years with a male preponderance; similar demographic details were noted in the present study. 8 The maxillary sinus was the most common affected site. The fungus gains entry into through nose and sinuses directly or blood vessels as it can penetrate vascular system.…”

“…7 The conditions that interfere with or reduce immunity like uncontrolled diabetes mellitus, haematological and other malignancies, neutropenia, organ transplantation, neutropenia, and corticosteroid or immunosuppressive therapy, acquired immunodeficiency syndrome (AIDS), and COVID-19 predispose to mucomycosis. 8 Mucormycosis was first described in 1876 in Germany by Fürbinger in a cancer patient's lung; which revealed a haemorrhagic infarct with fungal hyphae and a few sporangia. 9 In 1885, the description of mucormycosis was first published by Paltauf; it is described the most lethal and rapidly progressing form of fungal infection, initiated by saprophytic fungi such as Rhizopus and Mucor.…”

“…The fungus gains entry into through nose and sinuses directly or blood vessels as it can penetrate vascular system. 8 Thereby causing thrombosis, ischemia and necrosis; rapid spread to adjacent tissue. 10 Soft tissue necrosis was noted all cases in current study.…”

Clinical Phenotypes of COVID-19 Associated Mucormycosis (CAM): A Comprehensive Review

“…In addition, studies including patients with invasive fungal infections in general, and not mucormycosis specifically, and studies including mucormycosis cases not associated with COVID-19 and not separately with CAM cases were excluded. Sixteen studies were excluded due to unavailable–insufficient information [ 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ]. Four studies were excluded as they included patients with non-microbiologically confirmed SARS-CoV-2 infection [ 25 , 26 , 27 , 28 ].…”