Histomorphological Spectrum of Mucormycosis in Post Covid Patients

Introduction: The world faced deadly Covid-19 virus which was declared as Pandemicby WHO in March 2020. Covid-19 is known to be associated with immunedysregulation, which is further worsened by comorbidities & by widespread use ofimmunosuppressive agents and antibiotics.In our study, we studied the morphologicalspectrum of mucormycosis in Covid-19 patients and the causal relationship ofmucormycosis with various clinicopathological factors. Material and Methods: Anobservational study conducted at tertiary care center from January 2021 to July 2021,156 patients with histologically proven cases of mucormycosis were included in thisstudy and concurrent or prior history of Covid-19 then obtained along with treatmentgiven. Special stains were performed wherever necessary. Statistical analysis was doneusing SPSS statistics version 20. Results: Out of 156 cases 73% (n=114) were maleand 26% (n=42) were female. Most of the patients were in the age group of 51-60years. Out of 156 cases, 68% (n=106) were diabetic, 20.5% (n=32) had hypertension,9% (n=14) had diabetes with hypertension and 11.5% (n=18) had no comorbidity.Steroid therapy was received by 64.1% (n=100) patients, of which 52% (n=81) were onoral steroids, 12.2% (n=19) were on iv steroids, 14.8% (n=23) were not on steroidtherapy and conclusive history about steroid intake was not available in 21.1% (n=33).Other important findings in our study include, history of receiving O2 therapy wasgiven by 62.1% (n=97) patients, lymphopenia was found in 48% (n=75) patients.Statistically significant association of mucormycosis was found with diabetes mellitusand steroid use. Morphologically, 92.9% (n=145) cases showed mucormycosis aloneand 7% (n=11) cases had additional infection by aspergillus. Rare morphologicalfeatures like conidial heads, bony invasion, perineural invasion and granulomaformation were also seen.Conclusion: Early diagnosis and treatment of secondaryfungal infections is essential to reduce the morbidity and mortality in patients withunderlying comorbidities such as diabetes mellitus. Role of special stains is vital inhighlighting the fungal hyphae with atypical morphology and in tiny necrotic biopsies.