Covid-19-Associated Mucormycosis: Histopathology of the Deadly Fungal Infection

TL;DR

This study examines the histopathology of mucormycosis in COVID-19 patients in India, highlighting the role of diabetes and steroids in increasing the risk of this deadly fungal infection.

Contribution

The study provides detailed histopathological insights into mucormycosis in the context of the COVID-19 pandemic.

Findings

Most patients had diabetes and used steroids, which are significant risk factors for mucormycosis.

Nasal cavity was the most common biopsy site, with characteristic fungal hyphae observed in most cases.

Early diagnosis and treatment are critical for improving outcomes in mucormycosis patients.

Abstract

Introduction
 Many patients suffered from rhino-orbital-cerebral mucormycosis during the coronavirus disease 2019 (COVID-19) pandemic in India. Diabetes is a known risk factor of COVID-19 infection and mucormycosis.

Objective
 The present study was done to describe the clinical spectrum and histopathological findings of mucormycosis in COVID-19 patients and their outcomes.

Methods
 A cross-sectional study was done over a period of two and half months. The biopsy samples or scrapings from sinonasal or periorbital tissue of 38 patients were analyzed. Hematoxylin & Eosin (H&E stain) slides were evaluated along with Grocott-Gomori methenamine–silver and Periodic acid–Schiff stains to highlight the fungal elements.

Results
 The male to female ratio was 2.5:1, and the mean age of the subjects was 53 years old. A total of 68.4% (
n
 = 26/38) of the patients had diabetes as a comorbidity, 84.2% (
n
 = 32/38) had a history of steroid intake, and 55.3% (
n
 = 21/38) were given supplemental oxygen during their treatment. The common presentations were nasal blockage, discharge, eye pain, headache, and altered mentation. The sites of biopsy were: nasal cavity 76.3% (
n
 = 29/38), periorbital fat/orbit 21.1% (
n
 = 8/38), maxillary sinus 15.8% (
n
 = 6/38) and ethmoid sinus 13.2% (
n =
 5/38). In 76.3% (
n
 = 29/38) cases, broad, irregular, nonseptate, and right-angle branching hyphae were seen on H&E-stained tissue sections.

Conclusion
 COVID-19 led to various complications in individuals affected by it. Mucormycosis was one such lethal complication. An early diagnosis and prompt treatment is crucial to control the progression of the disease and improve outcomes.

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