Mixed invasive fungal infections among COVID-19 patients

Vanya  Singh; Amber   Prasad; Prasan   Kumar Panda; Manjunath Totaganti; Amit  Kumar Tyagi; Abhinav Thaduri; Shalinee   Rao; Mukesh  Bairwa; Ashok  Kumar Singh

doi:10.18502/cmm.7.4.8407

Vanya Singh Department of Microbiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
Amber Prasad Department of Microbiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
Prasan Kumar Panda Department of Internal Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
Manjunath Totaganti Department of Internal Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
Amit Kumar Tyagi Department of ENT, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
Abhinav Thaduri Department of ENT, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
Shalinee Rao Department of Pathology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
Mukesh Bairwa Department of Internal Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
Ashok Kumar Singh Department of Pathology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India

DOI: https://doi.org/10.18502/cmm.7.4.8407

Keywords: Aspergillosis Coronavirus disease Invasive fungal disease Mucormycosis

Abstract

Background and Purpose: The healthcare system in India collapsed during the second wave of the COVID-19 pandemic. A fungal epidemic was announced amid the pandemic with several cases of COVID-associated mucormycosis and pulmonary aspergillosis being reported. However, there is limited data regarding mixed fungal infections in COVID-19 patients. Therefore, we present a series of ten consecutive COVID-19 patients with mixed invasive fungal infections (MIFIs).

Materials and Methods: Among COVID-19 patients hospitalized in May 2021 at a tertiary care center in North India, 10 cases of microbiologically confirmed COVID-19- associated mucormycosis-aspergillosis (CAMA) were evaluated.

Results: All patients had diabetes and the majority of them were infected with severe COVID-19 pneumonia (6/10, 60%) either on admission or in the past month while two were each of moderate (20%) and mild (20%) categories of COVID-19; and were treated with steroid and cocktail therapy. The patients were managed with amphotericin-B along with surgical intervention. In total, 70% of all CAMA patients (Rhizopus arrhizus with Aspergillus flavus in seven and Aspergillus fumigatus complex in three patients) survived.

Conclusion: The study findings reflected the critical importance of a high index of clinical suspicion and accurate microbiological diagnosis in managing invasive dual molds and better understanding of the risk and progression of MIFIs among COVID-19 patients. Careful scrutiny and identification of MIFIs play a key role in the
implementation of effective management strategies.