Hit or Miss: The Dilemma of Specimen Selection for Microbiological Diagnosis of Rhino-Orbital-Cerebral- COVID-Associated Mucormycosis (ROCM-CAM)

We diagnosed various cases of rhino-orbital-cerebral- COVID-associated Mucormycosis (ROCM-CAM) during India's second wave of COVID-19. This helped formulate novel suggestions for improving laboratory output, applicable anywhere in the world. To diagnose ROCM-CAM by microbiological methods, we u...

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Bibliographic Details
Published in:	Infectious disorders drug targets Vol. 23; no. 1; p. e160822207524
Main Authors:	Jain, Vidhi, Aggarwal, Alisha, Shrimali, Twishi, Vishwakarma, Kirti, Paul, Debaleena, Kombade, Sarika Prabhakar, Sharma, Vidhu, Soni, Kapil, Choudhary, Bikram, Goyal, Amit, Chugh, Ankita, Tiwari, Sarbesh, Sharma, Deepak Kumar, Agarwal, Ashwini, Misra, Sanjeev
Format:	Journal Article
Language:	English
Published:	United Arab Emirates 01-02-2023
Subjects:	Antifungal Agents - therapeutic use Biopsy COVID-19 - diagnosis COVID-19 Testing Humans Mucormycosis - diagnosis Prospective Studies COVID-19 black fungus fungal culture Mucormycosis COVID-associated-mucormycosis rhino-orbito-cerebral
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Summary:	We diagnosed various cases of rhino-orbital-cerebral- COVID-associated Mucormycosis (ROCM-CAM) during India's second wave of COVID-19. This helped formulate novel suggestions for improving laboratory output, applicable anywhere in the world. To diagnose ROCM-CAM by microbiological methods, we used direct microscopy and conventional culture on various clinical samples within the shortest turn-around time. Prospective single-center observational study. Patients with ROCM-CAM. Of 113 suspected cases of ROCM-CAM during May 2021, direct microscopy and culture could confirm the disease in 87.61% and 44.25% of patients, respectively. The highest pathogen isolation was seen from maxillary bone fragments, FESS-guided biopsy from pterygopalatine fossae, nasal turbinates and nasal mucosal biopsy. Direct microscopy could diagnose the disease in almost 40% of patients within 24 hours and 60% within two days. Conventional cultures yielded Rhizopus spp. (86%) as the commonest fungal pathogen followed by Mucor spp. (12%) within 7 days. Deep tissue biopsies are more useful for rapid diagnosis than superficial specimens. Routine fungal cultures can supplement case detection and help prognosticate survivors. The management of ROCM is a surgical emergency. The diagnosis of the condition must therefore be prompt and precise. Despite ongoing antifungal therapy, nasal mucosal tissue, FESSguided, and intra-operative tissue biopsies showed the pathogen's highest diagnostic yield. The diagnostic index improved further when multiple (4-5) high-quality specimens were collected. Nasal swabs and crusts, among the most commonly requested specimens worldwide, were found to have an overall low diagnostic potential.
ISSN:	2212-3989
DOI:	10.2174/1871526522666220816110905