Mucormycosis: a rare but rising fungal infection in COVID-19 patients at tertiary care centre

Anuja A. Samale, Vimal S. Rathod, Sanjaykumar R. More, Atish B. Gujrathi


Background: New pandemic Coronavirus disease 2019 (COVID-19) shows wide range of disease pattern from mild to life threatening pneumonia in association with bacterial and fungal infections. Invasive fungal infections are becoming new burden in COVID-19 patients especially when associated with diabetes mellitus.

Methods: We have studied 90 patients of invasive fungal sinusitis at tertiary care centre over a period of 3 months from March 2021 to June 2021 prospectively. All patients suspected for invasive fungal sinusitis in association with covid19 are included.

 Results: 67 males and 23 females of age group 41 to 70 years were presented as case of invasive fungal sinusitis with suspicion of Mucormycosis. Disease extended to orbit in 90 patients, to hard palate in 33 and skin involved in 5 patients. Diagnosis based on clinical presentation, computed tomography (CT scan) findings, KOH preparation and culture. KOH showing fungal elements in 62 patients and fungi isolated in 37 patients. Aspergillus group and mucorales contribute equally being found in 17 samples each. 23 patients lost their life due to this disease. This study is done and reported first time from this tertiary care centre.

Conclusions: Invasive fugal sinusitis including Mucormycosis otherwise rare disease has significantly increased in COVID-19 pandemic. Immune dysregulation due to COVID-19, Diabetis mellitus and wide spread use of corticosteroids/antibiotics all contributed to this rise in cases of invasive fungal diseases. Early diagnosis, surgical intervention and antifungal treatment help to reduce mortality and morbidity.


COVID-19, Mucormycosis, Diabetis mellitus, SDA

Full Text:



Mehta S, Pandey A. Rhino-Orbital Mucormycosis Associated With COVID-19. Cureus. 2020;12(9):e10726.

Sarkar S, Gokhale T, Choudhury SS, Deb AK. COVID-19 and orbital mucormycosis. Indian J Ophthalmol. 2021;69:1002-4.

John TM, Jacob CN, Kontoyiannis DP. When Uncontrolled Diabetes Mellitus and Severe COVID-19 Converge: The Perfect Storm for Mucormycosis. J Fungi. 2021;7:298.

: Chennamchetty VK, Adimulapu S, Kola BP, Padua MD, Ambika C, Verma MK et al. Post-COVID pulmonary mucormycosis- A case report. IP Indian J Immunol Respir Med. 2021;6(1):62-6.

Bassetti M, Bouza E. Invasive mould infections in the ICU setting: complexities and solutions. J Antimicrob Chemother. 2017;72(1):i39-47.

Lin E, Moua T, Limper AH. Pulmonary mucormycosis: clinical features and outcomes. Infect. 2017;45(4):443-8.

Paltauf A. Mycosis mucorina. Virchows Arch PatholAnatPhysiolKlin Med. 1885;102:543-64.

Sen M, Lahane S, Lahane TP, Parekh R, Honavar SG. Mucor in a Viral Land: A Tale of Two Pathogens. Indian J Ophthalmol. 2021;69(2):244-52.

Werthman-Ehrenreich A. Mucormycosis with orbital compartment syndrome in a patient with COVID-19. Am J Emerg Med. 2020.

Fox A, Janson B, Stiff H, Chung A, Benage M, Van Heukelom J, et al. A multidisciplinary educational curriculum for the management of orbital compartment syndrome. Am J Emerg Med. 2020;38:1278-80.

Garg D, Muthu V, Sehgal IS, Ramachandran R, Kaur H, Bhalla A, Puri GD, Chakrabarti A, Agarwal R. Coronavirus Disease (Covid-19) Associated Mucormycosis (CAM): Case Report and Systematic Review of Literature. Mycopathologia. 2021;186(2):289-98.

Sharma S, Grover M, Bhargava S, Samdani S, Kataria T. Post coronavirus disease mucormycosis: a deadly addition to the pandemic spectrum. J LaryngolOtol. 2021;1-6.

Federation, International Diabetes. Idf Diabetes Atlas. 2019. Accessed on 10th May, 2021.

Prakash H, Ghosh AK, Rudramurthy SM, Singh P, Xess I et al. A Prospective Multicenter Study on Mucormycosis in India: Epidemiology, Diagnosis, and Treatment. Med. Mycol. 2019;57:395-402.

Revannavar SM, P S S, Samaga L. COVID-19 triggering mucormycosis in a susceptible patient: a new phenomenon in the developing world? BMJ Case Reports CP. 2021.

El-Kholy NA, El-Fattah AMA, Khafagy YW. Invasive Fungal Sinusitis in Post COVID-19 Patients: A New Clinical Entity. Laryngoscope. 2021.

Sebastian SK, Kumar VB, Gupta M, Sharma Y. Covid Assossiated Invasive Fungal Sinusitis. Indian J Otolaryngol Head Neck Surg. 2021;25:1-4.

Hanley B, Naresh KN, Roufosse C, Nicholson AG, Weir J, Cooke GS, et al. Histopathological findings and viral tropism in UK patients with severe fatal COVID-19: a postmortem study. Lancet Microbe. 2020;1(6):e245-53.

Mekonnen ZK, Ashraf DC, Jankowski T, Grob SR, Vagefi MR, Kersten RC, et al. Acute Invasive Rhino-Orbital Mucormycosis in a Patient With COVID-19-Associated Acute Respiratory Distress Syndrome. Ophthalmic PlastReconstr Surg. 2020.