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Infectious Disorders - Drug Targets

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

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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

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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-associatedmucormycosis

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