P295 Overview of post-covid mucormycosis in a tertiary care hospital in South India

POSTER SESSION 2, SEPTEMBER 22, 2022, 12:30 PM - 1:30 PM: INTRODUCTION: The unprecedented rise of COVID-associated Mucormycosis (CAM) cases even before the havoc caused by COVID-19 pandemic could settle posed a major challenge to the medical fraternity. COVID-associated Mucor had rapid dissemination, relentless progression and high fatality rates requiring a high index of clinical suspicion for early diagnosis and aggressive management for a successful outcome. Herein, we report our experience in the management of COVID-associated Mucor mycosis patients. OBJECTIVES: To analyze the risk factors, clinical presentation, diagnostic information, and treatment data of COVID-associated Mucormycosis patients treated in our hospital. METHOD: A Retrospective Observational study was done on the clinical, microbiological, histopathological, imaging, and treatment data of 36 patients with Mucor mycosis in the setting of COVID-19 during the period of 2020-2022 and analyzed. RESULTS: Of the 36 patients analyzed, 27 were male and 9 were female. In all, 75% of patients (27) were diabetic, 24 patients (66%) had suffered SEVERE COVID-19 pneumonia. A total of 30 patients were treated with steroids; 28 patients required supplemental oxygen. The most common type was sino-nasal (26 patients) followed by rhino-orbital disease (5 patients), 30 patients developed clinical symptoms within 4 weeks of post-COVID status. Facial pain or swelling (27 patients) and headache (11 patients) were the common presenting symptoms. The most common diagnostic nasal endoscopy finding was necrotic debris with blackish crusts in the respective sinuses (28 patients). Cross sectional-imaging (CT and/or MRI) showed involvement of paranasal sinus in 26 patients, orbital in 5 patients, and intracranial extension in 2 patients. Histopathological examination of the surgically debrided tissue showed tissue invasion in 23 patients and 9 patients had angioinvasion as well. Mucorales spp (24) was the most common pathogen isolated followed by mixed infection with Aspergillus spp and Zygomycosis (9). A total of 7 patients had ITS sequencing and 8 patients had antifungal susceptibility testing done to guide the treatment. All patients with rhino-sinal disease underwent sinus debridement and patients with clinical suspicion of Mucormycosis were empirically started on Azole-based therapy. Liposomal amphotericin B was initiated after confirmation of Mucor mycosis and was limited to patients with extensive disease such as an orbital or cerebral extension or pathological evidence of angioinvasion. LAB was given for a period of 2 weeks (18 patients) overlapping with Azole-based therapy for a period of 6-8 weeks depending on the treatment response assessed in detail at follow-up by clinical recovery, repeat check endoscopy, and imaging. Azole-based therapy (IV followed by oral tablets) was given to 18 patients (12 received posaconazole and 6 received isavuconazole). Therapeutic drug monitoring was done in all patients receiving posaconazole and where appropriate in 11 patients. Redebridement was required in 6 patients due to disease progression. Overall survival was 72% (26) and mortality 16% (6). Remaining patients (4) lost follow-up. CONCLUSION: 1. Uncontrolled diabetes, steroidal therapy, oxygen supplementation, and COVID-related immune dysregulation are significant risk factors for the development of COVID-associated Mucormycosis. 2. Early diagnosis and adequate surgical debridement allow usage of antifungal therapy for a short duration with good clinical outcomes.