Prevalence, predictors and outcome of pulmonary mucormycosis in COVID-19 associated rhino orbital mucormycosis in a tertiary care centre in south India

Background and Purpose: India witnessed an explosive rise in mucormycosis following COVID-19 infection. While rhino orbital mucormycosis was the most common presentation, pulmonary mucormycosis was closely followed. The need for advanced resources and lack of clinical suspicion for COVID-19-associated pulmonary mucormycosis led to widespread underdiagnosis and poor response to late therapy. The study aimed to assess the prevalence of pulmonary mucormycosis in COVID-19-associated rhino-orbital mucormycosis using non-invasive techniques like sputum microscopy and chest imaging. Materials and methods: A prospective observational study was conducted at the Institute of Internal Medicine, Rajiv Gandhi Government General Hospital between June 2021 and July 2021. All hospitalised patients with proven rhino orbital mucormycosis with or without cerebral involvement within three months of confirmed COVID-19 infection having clinical symptoms compatible with pulmonary mucormycosis were included in the study. These patients were screened for probable and possible COVID-19-associated pulmonary mucormycosis using CT chest imaging and sputum microscopy within 48 hours of hospital admission.Results: Out of 50 patients with rhino-orbital mucormycosis, 16% had associated possible or probable pulmonary mucormycosis. All 8 patients were diabetics and had characteristic CT chest findings while only half had positive sputum microscopy. A higher prevalence of disseminated COVID-19-associated mucormycosis was noted among 51-60 years males with the use of corticosteroids and oxygen for COVID-19 therapy. The mortality was 100% in probably disseminated mucormycosis, 50% in possible disseminated mucormycosis and only 9.5% in isolated rhino-orbital mucormycosis. Conclusion: Hence, non-invasive and feasible methods such as sputum microscopy and chest imaging can be considered for early screening and intensive management of probably disseminated mucormycosis to improve prognosis.