An Experience in Laboratory Diagnosis of Fungal Infections in COVID-19 Patients

Boorgula, Sushma Yadav; Yelamanchili, Sadhana; Sistla, Srinivas Kishore; Saher, Lubna; Gujjarlapudi, Deepika; E, Shalini; Devi V, Sindhu; Duvvur, Nageshwar Reddy

doi:10.1055/s-0043-1768140

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International Archives of Otorhinolaryngology

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Sumário

Original Research • Int Arch Otorhinolaryngol 28 (2) • 2024 • https://doi.org/10.1055/s-0043-1768140 copy

An Experience in Laboratory Diagnosis of Fungal Infections in COVID-19 Patients

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has cast a gloom spell on healthcare worldwide, infecting millions of people.

Objective

The aim of the present study is to determine the prevalence and review the contributing comorbidities and the precipitating factors leading to the emergence of the fungal infections in COVID-19-affected patients. To assess the utility of different laboratory techniques for confirmation of fungal infections. To assess the strengths and limitations of the diagnostic methods.

Methods

We have studied 252 clinical samples obtained from 121 COVID-positive patients.

Results

Among the 121 patients clinically diagnosed with fungal infections, 88 had diabetes and were given steroids for treatment (p-value = 0.001). Ninety-five patients (78.5%) had a positive laboratory diagnosis (either culture positive, potassium hydroxide [KOH]-positive or positive histopathology report). Fungal culture was positive in 75 (61.9%) patients and histopathology report was positive in 62 (51.2%). Histopathology was positive in 7 (5.8%) patients in whom culture and KOH were negative.

Conclusion

Aggressive treatment methods, administration of immune suppressants, and antibiotics, with an intention to salvage, have made patients susceptible to the benign fungus, causing it to evade the host immunity, thus leading to invasive infections. Applying different laboratory modalities would not only aid in providing fast and valuable information but also help in understanding the pathology which would assist the clinician in selecting the correct treatment for the patient.

Keywords
COVID-19; sars-cov-2; diabetes mellitus; steroids; fungus

	Alive	Dead
Males	92 (94.8%)	5 (5.15%)
Females	22 (91.66%)	2 (8.33%)

Culture result	KOH result	Histopathology result	Total nr. of patients
Negative	Negative	Positive	7
Positive	Positive	Positive	37
Negative	Positive	Negative	2
Negative	Negative	Negative	26
Positive	Negative	Positive	19
Negative	Positive	Positive	10
Positive	Negative	Positive	5
Positive	Positive	Negative	15

Name of the site	Total nr. of specimens collected
Maxilla	129 (51.1%)
Ethmoid	69 (27.3%)
Nose	22 (8.73%)
Orbit	13 (5.15%)
Sphenoid	10 (3.96%)
Frontal	6 (2.38%)
Lamina papyri mucosa	2 (0.79%)
Mastoid cells	1 (0.39%)
Total	252

Name of the fungus	Fungal culture positive	KOH	Histopathology	Site obtained from
Mucor N = 56	56	41-positive, 15-negative	36-positive, 7-negative, 5-chronic inflammation 8-acute inflammation	Maxilla-25 Ethmoid-23 Nose-7 Lamina payre-1
Rhizopus N = 38	38	31- positive 7-negative	23-positive for fungus 8- inflammation 7-negative	Maxilla-19 Ethmoid-12 Sphenoid-2 Orbit-2 Nose-2
Aspergillus N = 13	13	13-positive	3-positive for fungus 1- Acute inflammation 2-chronic inflammation	Maxilla-6 Nose-4 Orbit-1 Ethmoid-1 Sphenoid-1
Absidia N = 5	5	1-positive 4-negative	3-positive for fungal growth 1- Necrotic inflammation 1- Negative	Ethmoid-2 Middle turbinate (nose)-2 Frontal-1
Alternaria N = 4	4	4-negative	Acute inflammation-2 Chronic granulomatous inflammation-2	Ethmoid- 3 Left maxilla-1

No of sites	no	%
one	63	52.1
two	40	33.1
three and above	18	14.8
total	121	100

Name of site	no	%
Maxillary alone	49	40.5
Maxillary and combinations	55	45.5
Ethmoid one	6	5.0
Ethmoid and combinations	7	5.7
(Excluding maxillary)
Others	4	3.3
Total	121	100

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[1] Address for correspondence Boorgula Sushma Yadav, MD, Department of Microbiology, AIG Hospitals, Hyderabad, Telangana, India (e-mail: sushma.boorgula@gmail.com).