Prevalence of Orofacial Mucormycosis in Coronavirus Disease-2019 Patients: Insights from a Tertiary Care Center in Northern India

Introduction:The severe acute respiratory syndrome coronavirus 2 that is the cause of the coronavirus disease-2019 (COVID-19) pandemic is linked to a variety of opportunistic bacterial and fungal coinfections. Orofacial mycoses, fungal infections affecting the oral and facial regions, have recently gained attention as potential complications in individuals with COVID-19. Materials and Methods:This study aims to contribute to the understanding of orofacial mucormycosis in the context of COVID-19, particularly focusing on the prevalence among patients in a tertiary care center in Northern India. This study comprised respiratory materials from 255 COVID-19 patients treated at Max Hospital, Saket. The laboratory received specimens for microbiological pneumonia workup culture and molecular detection. Results:The most prevalent site for mucormycosis was the rhino-orbital region, accounting for a majority of cases at 58.2%. Following the rhino-orbital region, the involvement extended to the rhino-orbital-cerebral region in a notable proportion of cases. Pulmonary sites were identified as a significant location for mucormycosis, though less frequent compared to the rhino-orbital region. Mucormycosis diagnoses were predominantly made using direct microscopy, with 82.6% (196/255) of patients undergoing this diagnostic method. Conclusion:Our study in Northern India revealed a high prevalence of orofacial mucormycosis in middle-aged diabetic males, often with a history of COVID-19 hospitalization and steroid use. Rhizopus spp. were the most common Mucorales identified, with treatment challenges due to antifungal resistance. Molecular tests, such as matrix-assisted laser desorption ionization-time of flight, are valuable for species identification, emphasizing the need for heightened awareness during the COVID-19 pandemic.