Mixed invasive fungal infections among COVID-19 patients

Background and Purpose: The healthcare system in India collapsed during the secondwave 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 atertiary 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 severeCOVID-19 pneumonia (6/10, 60%) either on admission or in the past month while twowere each of moderate (20%) and mild (20%) categories of COVID-19; and were treatedwith 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)survived.Conclusion: The study findings reflected the critical importance of a high index ofclinical suspicion and accurate microbiological diagnosis in managing invasive dualmolds and better understanding of the risk and progression of MIFIs among COVID-19patients. Careful scrutiny and identification of MIFIs play a key role in theimplementation of effective management strategies