Features and evaluation of mucormycosis in COVID-19 patients from two referral hospitals in Iran

Hamed Fakhim; Shirin Irani; Zeynab Yassin; Hamid Badali; Elahe Nasri; Yasser Nasoori; Seyedhadi Samimiardestani; Saleh Mohebbi; Mojtaba Mohammadi Ardehali; Pegah Alizadeh Pahlavan; Mohammadreza Firouzifar; Ardavan Tajdini; Samira Ahadi; Afsane Vaezi

doi:10.1016/j.mycmed.2024.101480

Features and evaluation of mucormycosis in COVID-19 patients from two referral hospitals in Iran

J Mycol Med. 2024 Apr 30;34(2):101480. doi: 10.1016/j.mycmed.2024.101480. Online ahead of print.

Affiliations

¹ Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
² Otorhinolaryngology Research Center, Amir Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran.
³ Antimicrobial Resistance Research Center, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran.
⁴ Department of Molecular Microbiology & Immunology/South Texas Center for Emerging Infectious Diseases, The University of Texas at San Antonio, San Antonio, TX, USA.
⁵ ENT and Head & Neck Research Center, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran.
⁶ Skull base Research Center, Five sense health institute, Rasool Akram Medical Complex, Iran University of Medical Sciences, Tehran, Iran.
⁷ ENT and Head & Neck Research Center and Department, Hazrat Rasoul Hospital, The Five Senses Health Institute, Iran University of Medical Sciences, Tehran, Iran.
⁸ Department of Medical Laboratory Sciences, School of Allied Medical Sciences, Iran University of Medical Sciences, Tehran, Iran. Electronic address: vaeziiafsane@gmail.com.

PMID: 38744060
DOI: 10.1016/j.mycmed.2024.101480

Abstract

Objectives: The present study aimed to assess the features, clinical characteristics, and species diversity among patients admitted to referral Hospitals for SARS-CoV-2 pneumonia and mucormycosis in Tehran, Iran, and the relationship between seasonal and species diversity was considered.

Methods: Confirmed COVID-19 patients with a positive reverse-transcriptase real-time (rRT-PCR) test for SARS-CoV2 were primarily included based on clinically suspected mucormycosis infection and confirmed by histopathology and mycology examination of biopsy specimens. The PCR technique was performed by the amplification of the high-affinity iron permease 1 (FTR1) gene for identification and discrimination between Rhizopus arrhizus and non- Rhizopus arrhizus isolates. In contrast, species identification of non-Rhizopus arrhizus was performed by sequencing of ITS rDNA region.

Results: Rhino-sino-orbital mucormycosis was identified in the majority of cases (n = 33), with 66 % and 34 % of the cases involving male and female patients, respectively. Rhizopus arrhizus was found to be the most prevalent (84.6 %), followed by Mucor circinelloides (7.6 %). Rhizopus arrhizus was the most prevalent species and present in all the seasons; however, Mucor circinelloides was only present in the autumn. The overall mortality of the total population was 24.6 % (16/ 65); the mortality rates occurring in patients diagnosed with rhino-sino-orbital infection and rhino-sinusal form were 21.4 % and 25 %, respectively.

Conclusion: CAM can be a serious complication of severe COVID-19, especially in patients with uncontrolled diabetes. It is important to monitor the epidemiology of mucormycosis to raise awareness of the disease and improve diagnosis, treatment and prognosis, particularly in the setting of pandemic.

Keywords: Covid-19; Diabetes; Iran; Mucorales; Mucormycosis; Sars-cov-2.