Expanding the Spectrum of Fatal Necrotizing Fungal Infections Presented as Sinonasal and Rhino Orbital Mucormycosis and Aspergillosis in Post Coronavirus Disease.
European Journal of Molecular & Clinical Medicine,
2021, Volume 8, Issue 4, Pages 101-110
AbstractThe present study is aimed to clinico pathologically characterize a subset of mucormycosis and aspergillosis cases presented as Sinonasal and rhino orbital fungal infection in post coronavirus disease. The study comprises a microscopic analysis of specific histopathologic variables on 35 cases of mucormycosis that were diagnosed and treated in a six month period. We reviewed Sino nasal and orbital biopsies of 35 patients whose specimens received in a tertiary care hospital histopathology lab. All patients were admitted for suspected fungal sinonasal and rhino orbital infections. Detailed microscopic examination and clinicopathological correlation study were done. Fungal load in the tissue (graded as mild, moderate and marked), degree of neutrophilic and granulomatous response, tissue invasion and necrosis were graded.
We noted that necrosis is seen in all cases. Co infections with aspergillosis are also commonly noted. Vascular changes are marked. Angioinvasion, bone marrow invasion and peri neural/neural invasion are frequently noted. Fungal culture can become negative in histologically proven mucormycosis. History of diabetes present in majority of cases. Use of glucocorticoids and hypoxemia is also noted in many cases. The prevalence of mucormycosis fungal infections is very high in post coronavirus patients especially in diabetic patients. Histopathologic examination remains one of the major diagnostic tools in diagnosis of mucormycosis. Early diagnosis with surgical excision, appropriate debridement, proper antifungal treatment and management of risk factors lead to subsequent reduction in mortality and morbidity.
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