Abstract

During the current pandemic of COVID-19 there are increased cases with super infections by mucormycosis. This study is performed with an aim to evaluate clinico histomorphological features of COVID-19 associated mucormycosis(CAM). Material and Methods: A total of 3365 COVID 19 positive cases were reported during the last 8 months. A total of 494 patients with COVID 19 were admitted for >24 hours during this study period. Among these 13 cases of mucormycosis were diagnosed. All cases were positive for Reverse transcriptase polymerase chain reaction RT PCR assay. The detail clinical examination and required investigations were included. The operative details and histopathological gross and microscopic findings were noted. The characteristics type of inflammation, necrosis, fungal hyphae, presence of granulomatous reaction, angioinvasion and perineural invasion,bony tissue pathology were noted. The special stain like PAS, Grocott Gomori's methenaminesilver stainwere done. The data was analysed. Results: The age range of patients was from 10 to 65 year. There was a male preponderance. The 6 (46%) patients had pre existing diabetes mellitus, 3 (23%) patients had received steroids during the treatment, 1 patient hadcoexisting HIV/AIDS infection, 3 (23%) patients had history of hypertension. The radio imaging revealed soft tissue swelling in the preseptal, malar, premaxillary and retrobulbar regions with paranasal sinusitis. Nasal involvement was seen in all 13 cases (100%), orbital involvement in 5 cases (37%) and cerebral involvement in 3 cases (23%). On histomorphological study characteristic fungal hyphae of mucormycosis were seen in all cases. The acute or chronic inflammation, necrosis were seen in all cases. The granulomatous reaction was seen in 23%, angioinvasion in 46% and perineural invasion in 15% cases. One case revealed co-exisisting HIV/AIDS and another with actinomycosis co-infection. Conclusions: In COVID 19 patients Mucormycosis is one of the important associated infection within this pandemic. This increase in incidence is related to various risk factors being systemic preexisting disease, IV infection, diabetics, use of steroid and immunosuppression etc.The mucormycosis patients are treated by early identification, monitoring risk factors, followed by proper surgical intervention and administration of the appropriate antifungal medication. This histopathological study will be of importance in early diagnosis and management of patients with COVID-19 and would help improve outcomes in world pandemic time. We are presenting these casesof CAM for its clinical, radio imaging, and histopathological findings.

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