Emerging COVID-associated Mucor-Aspergillosis – A Need of Separate Definition

PURPOSE: During COVID pandemic, several cases of isolated COVID-associated mucormycosis and COVID-associated pulmonary aspergillosis have been reported. There is no data regarding both infections in same patients. Herein, we present series of ten consecutive cases with dual invasive molds in patients infected with SARS-CoV-2. METHODS & MATERIALS: Among patients hospitalized with diagnosis of COVID in May 2021 at a tertiary care center in North India, ten microbiologically confirmed dual/mixed COVID-associated mucor-aspergillosis (CAMA) were analysed. We hypothesised case definition for Covid-associated mucormycosis and aspergillosis infection derived from EORTC/MSG, as possible, probable, and proven CAMA. RESULTS: Six men and four women had a mean age of 49.2 ± 8.8 years. All patients were diabetic with history of COVID pneumonia. Patients presented with headache, fever, altered sensorium, decrease vision, nasal obstruction, periorbital swelling, nasal stuffiness, nasal discharge. Rhizopus arrhizus was isolated in all, Aspergillus flavus in seven and Aspergillus fumigatus in three patients. Patient 2,5,6,8,9 were histopathologically proven dual infections with patient 3 & 7 having only angioinvasion. Patients received amphotericin B and all except 3 were managed by surgical debridement, the remaining 3 succumbed. CONCLUSION: These findings may help towards a better insight into the clinical profile of invasive CAMA and thus we propose a definition in connotation with EORTC/MSG for IFD.