Co-Infection of Mucormycosis and COVID-19: A Retrospective Cross-Sectional Study of Patients Admitted to Imam Khomeini Hospital in Ahvaz, Iran

Abstract

Background and aims: During the COVID-19 pandemic, the emergence of mucormycosis, a rare but often fatal fungal infection, gained significant attention due to its increased prevalence among immunocompromised patients. This study aimed to determine the prevalence and characterize the clinical features of COVID-19-associated mucormycosis in patients admitted to Imam Khomeini Hospital, Ahvaz, Iran.

Methods: This retrospective, cross-sectional study analyzed clinical data from patients admitted between November 2020 and November 2021. Inclusion criteria encompassed individuals with concurrent diagnoses of COVID-19 and mucormycosis. Data collected included demographic details, clinical features, comorbidities, laboratory findings, and treatment information. Descriptive statistics were used to summarize patient characteristics, and prevalence estimates were provided with 95% confidence intervals.

Results: Of the 12,978 hospitalized patients during the study period, 31 individuals (0.2%, 95% CI: 0.2%-0.3%) were diagnosed with COVID-19-associated mucormycosis. The prevalence was highest among male patients (54.8%) and those aged 60 years or older (48.4%). Diabetes was the most prevalent comorbidity, and the most frequent clinical symptoms included respiratory distress and cough. Patients with severe COVID-19 exhibited a significantly higher prevalence of co-infection, suggesting a greater vulnerability in this subgroup.

Conclusion: COVID-19-associated mucormycosis primarily affects elderly male patients with underlying diabetes and severe COVID-19 illness. These findings underscore the importance of early detection and intervention, particularly for high-risk individuals. Further research is warranted to optimize prevention and management strategies for this serious complication.

Keywords: COVID‐19 virus disease; Mucormycosis; co‐infection; fungal infections.

Figure 1

Axial CT scan of a patient with COVID‐19‐associated mucormycosis. This non‐enhanced axial CT scan shows notable mucosal thickening in the bilateral maxillary sinuses, consistent with sinonasal mucormycosis. The image also reveals partial opacification of both maxillary sinuses and the right nasal cavity, accompanied by air entrapment. These findings are characteristic of mucormycosis and illustrate the extent of sinonasal involvement in a patient concurrently diagnosed with COVID‐19.

Figure 2

Histopathological analysis of nasal mucosal glands in COVID‐19‐associated Mucormycosis. This histopathological smear from the left maxillary sinus highlights nasal mucosal glands with evident necrosis and mononuclear inflammatory cell infiltration, characteristic of mucormycosis. Broad, nonseptate, or pauciseptate hyphae are visible, displaying wide‐angle branching and significant tissue invasion. These fungal structures, typical of mucormycosis, are stained with Hematoxylin and Eosin at a magnification of 200×.

Figure 3

Frequency of Mucormycosis infection among assessed COVID‐19 patients.