P430 Correlation of microscopy and culture findings with serum ferritin level for the diagnosis of rhino-orbito-cerebral Mucormycosis during COVID-19 pandemic—a study from tertiary care hospital India

POSTER SESSION 3, SEPTEMBER 23, 2022, 12:30 PM - 1:30 PM: OBJECTIVES: Rhino-orbito-cerebral Mucormycosis (ROCM) is a fulminant manifestation with high morbidity and mortality rates. It was considered to be a notifiable disease during COVID-19 pandemic in India as per ICMR. Hence, this study was conducted to correlate microscopy (KOH) and culture findings with serum ferritin levels for the cases with suspected ROCM with diabetes mellitus (DM) as a primary risk factor presented to tertiary care hospitals in India during COVID-19 pandemic. METHODS: A prospective study was conducted during the COVID-19 second wave in 2021. Total 134 cases of suspected ROCM with DM were included in the study. Various types of samples received from Oto-rhino-laryngology department such as nasal crust, swab, secretions, lavage, biopsy, etc. They were subjected to KOH wet mount as well as culture on Sabouraud Dextrose Agar (SDA) with antibiotics and cycloheximide. Simultaneously serum samples were collected from all the patients for serum ferritin analysis. All of their COVID-19 status, Microcopy (KOH), and Culture findings were analyzed and correlated with serum ferritin levels. RESULTS: Of the 134 suspected ROCM cases with diabetes mellitus as a comorbidity, both KOH and culture positive for Mucorales such as Rhizopus species, Mucor species, Cunninghamella species, was 21.6% whereas KOH positive for Mucorales and culture positive for mixed growth such as Aspergillus species, Alternaria species, Bipolaris species, etc. was 10.4%. Serum ferritin level has been tested for all the cases and it is found to be increased by about 93%. Among these cases, 72% were confirmed COVID-19 positive. The mean age of these suspected ROCM patients was 62.3years, males were significantly more affected than females. CONCLUSION: Microscopy (KOH) and culture are the mainstays of the diagnosis of ROCM. Besides diabetic ketoacidosis as the primary underlying risk factor, high serum ferritin level was appeared to be an additional factor for the severity and manifestations of the disease.