Correlation of Pathological Manifestations in Covid 19 Positive Cases Complicated by Either Isolated Mucormycosis or Co-Infection with Other Fungi: Experiences of a Tertiary Level Institute

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Riddhi Jaiswal H S Malhotra D Himanshu


As a part of multi-disciplinary team of the institute in managing Covid positive patients as well as those admitted with its complications, Pathology department was reporting specimens of suspected fungal infection, received from clinical departments like neurosurgery, otorhinolaryngology, ophthalmology, oral and maxillofacial surgery, respiratory medicine, internal medicine etc. Simultaneous serology and various Covid associated blood parameters were being investigated during admission to hospital, as per the clinical scenario.

The aim of this paper is to discuss pathogenesis of fungal infections and bring out any significant pathological differences in Covid 19 positive cases afflicted subsequently by either mucor alone or mixed fungal infections.

Out of 274 tissue specimens received between April to November 2021, clinically suspected to be of Covid 19 associated mucormycosis, we found 14 cases of simultaneous co-infection with other species of fungi. 45 specimens were reported negative for fungal elements while 229 were confirmed by histo pathological examination.

Cases were grouped according to the presence of either only Mucormycosis on histology or mucor with co-infecting fungi.Various biochemical, hematological and histopathological parameters were compared and significance of difference analysed using student t test in the two groups.

Statistically significant differnce was observed in mean values of serum ferritin (p value 0.005); C-Reactive Protein/CRP (p value 0.003); serum creatinine, Random Blood Sugar/RBS, Haemoglobin, Total Leuocyte Count/TLC and duration of hospital stay (p value of each being 0.00) while p value was insignificant in serum Lactate Dehydrogenase/LDH and InterLeukin 6/IL6 values between the two groups.

Platelet count of patients in both the groups were within normal range. (1-4.5 x1000/cu mm). None of the Histopathological parameters showed any statistically significant difference in the two groups (p value of each was more than 0.05).


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JAISWAL, Riddhi; MALHOTRA, H S; HIMANSHU, D. Correlation of Pathological Manifestations in Covid 19 Positive Cases Complicated by Either Isolated Mucormycosis or Co-Infection with Other Fungi: Experiences of a Tertiary Level Institute. Medical Research Archives, [S.l.], v. 10, n. 3, mar. 2022. ISSN 2375-1924. Available at: <>. Date accessed: 14 june 2024. doi:


1. Brad Spellberg, John Edwards, Jr.,
and Ashraf Ibrahim. Novel Perspectives on Mucormycosis: Pathophysiology, Presentation, and Management. Clin Microbiol Rev. 2005 Jul; 18(3): 556–569.

2. Rit K, Saha R, Dey R, Barik G. Rhino-oculo-cerebral Aspergillus and mucor co-infections in an immunocompromised patient with type 2 diabetes mellitus. Med J DY Patil Univ. 2014;7:486-8.

3. Alfano C, Chiummariello S, Dessy LA, Bistoni G, Scuderi N. Combined mucormycosis and aspergillosis of the rhinocerebral region. In Vivo. 2006;20:311-5.

4. Skiada A, Lantenier F et al. Diagnosis and treatment of mucormycosis in patients with hematological malignancies; guidelines for the 3rd European Conference on Infections in Leukemia (ECIL3). Haematologica. 2013 Apr; 98 (4):492-504.

5. Walsh TJ, Gamaletsou MN, McGinnis MR, Hayden RT, Kontoyiannis DP. Early clinical & amp; laboratory diagnosis of invasive pulmonary, extrapulmonary and disseminated mucormycosis (Zygomycosis). Clin Infect Dis. 2012 Feb; Suppl 1:S55-60.

6. Nagarkar NM, Verma H, Punia R. Co-existing mucormycosis with aspergillosis in a patient with diabetes mellitus- first case report. Online J Otolaryngol. 2014; 4:257-64.

7. Maiorano E, Favia G, Capodiferro S, Montagna MT, Lo Muzio L. Combined mucormycosis and aspergillosis of the oro-sinonasal region in a patient affected by Castleman disease. Virchows Arch. 2005;446:28-33.

8. Goswami S, Vohra R, Raju BM, Agarwal A. Concomitant Mucormycosis and Aspergillosis of Rhinocerebral Region in a Renal Transplant Patient – Air Cooler Being the Culprit. Indian Journal of Medical Case Reports. 2016:5;30-34.

9. Wael F. Ismaiel, Mohamed H. Abdelazim, Ibrahim Eldsoky, Ahmed A. Ibrahim, Mahmoud E. Alsobky, Ebtesam Zafan, and Abdulkarim Hasan. The impact of COVID-19 outbreak on the incidence of acute invasive fungal rhinosinusitis. Am J Otolaryngol. 2021 November-December; 42(6): 103080.

10. Song G, Liang G, Liu W. Fungal Co-infections associated
with global COVID-19 pandemic: a clinical and diagnostic perspective from China. Mycopathologica. 2020 Aug;185(4):599-606.

11. Suwarna SK, Layton C, Bancroft John D.
Bancroft’s theory and Practice of Histological Techniques. 8th Edition. Elsevier. 2019. ISBN: 978-0-7020-6864-5

12. T Sravani, S Gurlingappa Uppin et al. Rhinocerebral mucormycosis: Pathology revisited with emphasis on perineural spread. Neurology India. 2014;62:4;383-386.
13. Ashraf S, Ibrahim et al. Pathogenesis of mucormycosis . Clin Infect Dis. 2012; 54 Suppl1: S16-22.
14. Vare AA, Yellambkar S, Farheen A, Nandedkar V, Bhombe SS, Shah R. Vare AA, et al. Incidence, cumulative mortality and factors affecting the outcome of COVID-19-associated mucormycosis from Western India. Indian J Ophthalmol. 2021 Dec;69(12):3678-3683.
15. Patel A, Agarwal R, Radhamurthy SM et al. Multicenter epidemiologic study of coronavirus disease-associated mucormycosis, India. Emerg Infect Dis. 2021; 27 (9):2349-2359.
16. Minet C, Bonadona A et al. Non fatal disseminated mucormycosis in a solid organ transplant. Rev Mal Respir. 2009 Nov;26(9):998-1002.
17. Reid G, Lynch JP 3rd et al. Mucormycosis. Semin Respir Crit Care Med. 2020 Feb;41 (1):99-114.
18. Samson R, Dharne M. COVID -19 associated mucormycosis: evolving technologies for early and rapid diagnosis. Biotech. 2022 Jan;12(1):6.
19. Mahalaxmi I, Jayaramayya K et al. Mucormycosis: an opportunistic pathogen during COVID 19. Environ Res. 2021 Oct; 201:111643.
20. Dubey D, Mishra S, Reddy H, Rizvi A & Ali W. Hematological and serum biochemistry parameters as a prognostic indicator of severally ill versus mild Covid-19 patients: A study from tertiary hospital in North India. Clinical Epidemiol Glob Health. 2021 Oct-Dec; 12:100806.

21.Dadwal SS, Kontoyjannis DP. Recent advances in the molecular diagnosis of mucormycosis. Expert Rev of Mol Diagn. 2018 Oct; 18(10):845-854.

22. Malhotra HS, Jaiswal R, Puri B et al. COVID-19 associated mucormycosis: Staging and management recommendations (Report of a multi-disciplinary expert committee).
J Oral Biol Craniofac Res. 2021 Oct-Dec; 11(4): 569–580.