Mixed invasive fungal infections among COVID-19 patients

Document Type : Original Articles


1 Department of Microbiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, Indi

2 Department of Internal Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India

3 Department of ENT, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India

4 Department of Pathology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India



Background and Purpose: The healthcare system in India collapsed during the second
wave of the COVID-19 pandemic. A fungal epidemic was announced amid the pandemic with several cases of COVID-associated mucormycosis and pulmonary aspergillosis being reported. However, there is limited data regarding mixed fungal infections in COVID-19 patients. Therefore, we present a series of ten consecutive COVID-19 patients with mixed invasive fungal infections (MIFIs).
Materials and Methods: Among COVID-19 patients hospitalized in May 2021 at a
tertiary care center in North India, 10 cases of microbiologically confirmed COVID-19-
associated mucormycosis-aspergillosis (CAMA) were evaluated.
Results: All patients had diabetes and the majority of them were infected with severe
COVID-19 pneumonia (6/10, 60%) either on admission or in the past month while two
were each of moderate (20%) and mild (20%) categories of COVID-19; and were treated
with steroid and cocktail therapy. The patients were managed with amphotericin-B along with surgical intervention. In total, 70% of all CAMA patients (Rhizopus arrhizus with Aspergillus flavus in seven and Aspergillus fumigatus complex in three patients)
Conclusion: The study findings reflected the critical importance of a high index of
clinical suspicion and accurate microbiological diagnosis in managing invasive dual
molds and better understanding of the risk and progression of MIFIs among COVID-19
patients. Careful scrutiny and identification of MIFIs play a key role in the
implementation of effective management strategies.



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Volume 7, Issue 4
December 2021
Pages 19-27
  • Receive Date: 23 September 2021
  • Revise Date: 06 January 2022
  • Accept Date: 07 January 2022
  • First Publish Date: 07 January 2022