Login Register Cart 0
Generic placeholder image

Infectious Disorders - Drug Targets

Editor-in-Chief

ISSN (Print): 1871-5265
ISSN (Online): 2212-3989

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Research Article

Hit or Miss: The Dilemma of Specimen Selection for Microbiological Diagnosis of Rhino-Orbital-Cerebral- COVID-Associated Mucormycosis (ROCM-CAM)

Author(s): Vidhi Jain*, Alisha Aggarwal, Twishi Shrimali, Kirti Vishwakarma, Debaleena Paul, Sarika Prabhakar Kombade, Vidhu Sharma, Kapil Soni, Bikram Choudhary, Amit Goyal, Ankita Chugh, Sarbesh Tiwari, Deepak Kumar Sharma, Ashwini Agarwal and Sanjeev Misra

Volume 23, Issue 1, 2023

Published on: 03 October, 2022

Article ID: e160822207524 Pages: 8

DOI: 10.2174/1871526522666220816110905

Price: $65

Open Access Journals Promotions 2
conference banner
Abstract

Background: We diagnosed various cases of rhino-orbital-cerebral- COVID-associated Mucormycosis (ROCM-CAM) during India's second wave of COVID-19. This helped formulate novel suggestions for improving laboratory output, applicable anywhere in the world.

Methods: To diagnose ROCM-CAM by microbiological methods, we used direct microscopy and conventional culture on various clinical samples within the shortest turn-around time.

Design: Prospective single-center observational study.

Participants: Patients with ROCM-CAM.

Results: Of 113 suspected cases of ROCM-CAM during May 2021, direct microscopy and culture could confirm the disease in 87.61% and 44.25% of patients, respectively. The highest pathogen isolation was seen from maxillary bone fragments, FESS-guided biopsy from pterygopalatine fossae, nasal turbinates and nasal mucosal biopsy. Direct microscopy could diagnose the disease in almost 40% of patients within 24 hours and 60% within two days. Conventional cultures yielded Rhizopus spp. (86%) as the commonest fungal pathogen followed by Mucor spp. (12%) within 7 days. Deep tissue biopsies are more useful for rapid diagnosis than superficial specimens. Routine fungal cultures can supplement case detection and help prognosticate survivors.

Conclusion: The management of ROCM is a surgical emergency. The diagnosis of the condition must therefore be prompt and precise. Despite ongoing antifungal therapy, nasal mucosal tissue, FESSguided, and intra-operative tissue biopsies showed the pathogen's highest diagnostic yield. The diagnostic index improved further when multiple (4-5) high-quality specimens were collected. Nasal swabs and crusts, among the most commonly requested specimens worldwide, were found to have an overall low diagnostic potential.

Keywords: Mucormycosis, COVID-19, rhino-orbito-cerebral, black fungus, fungal culture, COVID-associated-mucormycosis.

[1]
Cherian S, Potdar V, Jadhav S, Yadav P, Gupta N, Das M. Convergent evolution of SARS-CoV-2 spike mutations, L452R, E484Q and P681R, in the second wave of COVID-19 in Maharashtra, India. Microorganisms 2021; 9(7): 1542.
[http://dx.doi.org/10.1101/2021.04.22.440932]
[2]
Evidence-based advisory in the time of COVID-19 for screening, diagnosis and management of mucormycosis. ICMR. Available from: https://www.icmr.gov.in/pdf/covid/techdoc/Mucormycosis_ADVISORY_FROM_ICMR_In_COVID19_time.pdf
[3]
Hoenigl M, Seidel D, Carvalho A, et al. The emergence of COVID-19 associated mucormycosis: Analysis of cases from 18 countries. Lancet Microbe 2022; 37(7): e543-52.
[4]
Song G, Liang G, Liu W. Fungal co-infections associated with global COVID-19 pandemic: A clinical and diagnostic perspective from China. Mycopathologia 2020; 185(4): 599-606.
[http://dx.doi.org/10.1007/s11046-020-00462-9] [PMID: 32737747]
[5]
Sen M, Honavar SG, Bansal R, et al. Epidemiology, clinical profile, management, and outcome of COVID-19-associated rhino-orbital-cerebral mucormycosis in 2826 patients in India - collaborative OPAI-IJO study on mucormycosis in COVID-19 (COSMIC), report 1. Indian J Ophthalmol 2021; 69(7): 1670-92.
[http://dx.doi.org/10.4103/ijo.IJO_1565_21] [PMID: 34156034]
[6]
Honavar SG. Code mucor: Guidelines for the diagnosis, staging and management of rhino-orbito-cerebral mucormycosis in the setting of COVID-19. Indian J Ophthalmol 2021; 69(6): 1361-5.
[http://dx.doi.org/10.4103/ijo.IJO_1165_21]
[7]
Rudramurthy SM, Hoenigl M, Meis JF, et al. ECMM/ISHAM recommendations for clinical management of COVID-19 associated mucormycosis in low- and middle-income countries. Mycoses 2021; 64(9): 1028-37.
[http://dx.doi.org/10.1111/myc.13335] [PMID: 34133816]
[8]
Prakash H, Chakrabarti A. Global epidemiology of mucormycosis. J Fungi (Basel) 2019; 5(1): E26.
[http://dx.doi.org/10.3390/jof5010026] [PMID: 30901907]
[9]
Chakrabarti A, Dhaliwal M. Epidemiology of mucormycosis in India. Curr Fungal Infect Rep 2013; 7: 287-92.
[http://dx.doi.org/10.1007/s12281-013-0152-z]
[10]
Roden MM, Zaoutis TE, Buchanan WL, et al. Epidemiology and outcome of zygomycosis: A review of 929 reported cases. Clin Infect Dis 2005; 41(5): 634-53.
[http://dx.doi.org/10.1086/432579] [PMID: 16080086]
[11]
Jeong W, Keighley C, Wolfe R, et al. The epidemiology and clinical manifestations of mucormycosis: A systematic review and meta-analysis of case reports. Clin Microbiol Infect 2019; 25(1): 26-34.
[http://dx.doi.org/10.1016/j.cmi.2018.07.011] [PMID: 30036666]
[12]
Patel A, Kaur H, Xess I, et al. A multicentre observational study on the epidemiology, risk factors, management and outcomes of mucormycosis in India. Clin Microbiol Infect 2020; 26(7): 944.e9-944.e15.
[http://dx.doi.org/10.1016/j.cmi.2019.11.021] [PMID: 31811914]
[13]
Skiada A, Pavleas I, Drogari-Apiranthitou M. Epidemiology and diagnosis of mucormycosis: An update. J Fungi (Basel) 2020; 6(4): E265.
[http://dx.doi.org/10.3390/jof6040265] [PMID: 33147877]
[14]
Chander J, Kaur M, Singla N, et al. Mucormycosis: battle with the deadly enemy over a five-year period in India. J Fungi (Basel) 2018; 4(2): E46.
[http://dx.doi.org/10.3390/jof4020046] [PMID: 29642408]
[15]
Chakrabarti A, Das A, Mandal J, et al. The rising trend of invasive zygomycosis in patients with uncontrolled diabetes mellitus. Med Mycol 2006; 44(4): 335-42.
[http://dx.doi.org/10.1080/13693780500464930] [PMID: 16772227]
[16]
Chakrabarti A, Chatterjee SS, Das A, et al. Invasive zygomycosis in India: Experience in a tertiary care hospital. Postgrad Med J 2009; 85(1009): 573-81.
[http://dx.doi.org/10.1136/pgmj.2008.076463] [PMID: 19892892]
[17]
Kolekar JS. Rhinocerebral mucormycosis: A retrospective study. Indian J Otolaryngol Head Neck Surg 2015; 67(1): 93-6.
[http://dx.doi.org/10.1007/s12070-014-0804-5] [PMID: 25621242]
[18]
Prakash H, Ghosh AK, Rudramurthy SM, et al. A prospective multicenter study on mucormycosis in India: Epidemiology, diagnosis, and treatment. Med Mycol 2019; 57(4): 395-402.
[http://dx.doi.org/10.1093/mmy/myy060] [PMID: 30085158]
[19]
Fouad YA, Abdelaziz TT, Askoura A, et al. Spike in rhino-orbital-cerebral mucormycosis cases presenting to a tertiary care center during the COVID-19 pandemic. Front Med (Lausanne) 2021; 8: 645270.
[http://dx.doi.org/10.3389/fmed.2021.645270] [PMID: 34124087]
[20]
Sarkar S, Gokhale T, Choudhury SS, Deb AK. COVID-19 and orbital mucormycosis. Indian J Ophthalmol 2021; 69(4): 1002-4.
[http://dx.doi.org/10.4103/ijo.IJO_3763_20] [PMID: 33727483]
[21]
Garg D, Muthu V, Sehgal IS, et al. Coronavirus disease (COVID-19) associated mucormycosis (CAM): Case report and systematic review of literature. Mycopathologia 2021; 186(2): 289-98.
[http://dx.doi.org/10.1007/s11046-021-00528-2] [PMID: 33544266]
[22]
Patel A, Agarwal R, Rudramurthy SM, et al. Multicenter epidemiologic study of coronavirus disease-associated mucormycosis, India. Emerg Infect Dis 2021; 27(9): 2349-59.
[http://dx.doi.org/10.3201/eid2709.210934] [PMID: 34087089]
[23]
Raut A, Huy NT. Rising incidence of mucormycosis in patients with COVID-19: Another challenge for India amidst the second wave? Lancet Respir Med 2021; 9(8): e77.
[http://dx.doi.org/10.1016/S2213-2600(21)00265-4] [PMID: 34090607]
[24]
Ramaswami A, Sahu AK, Kumar A, et al. COVID-19 associated Mucormycosis presenting to the emergency department–an observational study of 70 patients. QJM 2021; 114(7): 464-70.
[25]
Whiting DR, Guariguata L, Weil C, Shaw J. IDF diabetes atlas: Global estimates of the prevalence of diabetes for 2011 and 2030. Diabetes Res Clin Pract 2011; 94(3): 311-21.
[http://dx.doi.org/10.1016/j.diabres.2011.10.029] [PMID: 22079683]
[26]
Mishra Y, Prashar M, Sharma D, Kumar VP, Tilak TV. Diabetes, COVID-19 and mucormycosis: Clinical spectrum and outcome in a tertiary care medical center in Western India. Diabetes Metab Syndr 2021; 15(4): 102196.
[http://dx.doi.org/10.1016/j.dsx.2021.102196] [PMID: 34246939]

Rights & Permissions Print Cite
Article Metrics
17
2
Wayfinder Image
Open Access Journals Promotions
World AIDS Day
© 2024 Bentham Science Publishers | Privacy Policy