Post COVID 19 fungal lung infections: Experience from a tertiary care Institute

ABSTRACT

Background: COVID-19 and its treatment with corticosteroids and immunosuppressive therapy, mechanical ventilation, contaminated oxygen humidifier systems, prolonged hospital stay and uncontrolled diabetes mellitus increase the risk of fungal infections. Methodology: Inclusion criteria were patients with (i) recovery from moderate to severe COVID 19 & (ii) new onset cavitary lung lesions. Exclusion criteria were rhino orbito cerebral mucormycosis (ROCM). Results: Of all the 44 patients, (40, 90.9%) were males and never smoker (32, 72.7%). Mean age was 59.7 years. Comorbidities were DM (20, 45.4%) with HbA1c>5.4% in 16 (36.3%) and HTN (16, 36.3%). Mean ESR was 81.5 mm/1 hr & CRP was 112 mg/L. 22 (50%) underwent mechanical ventilation. Presenting symptoms were fever (34, 77.27%) and hemoptysis (28, 63.6%). Mean d-dimer was 1.93 g/ dL. Sputum yielded growth on fungal smear culture in 8 (18.18%). BAL galactomannan was raised in 26(59.1%) patients. 30 (68.2%) had cavitatory lesion in right lung with upper lobe involvement in (16, 53.3%). 36 (81.8%) patients underwent FOB. Most common endobronchial appearance was thick whitish mucoid secretions. 2 (4.5%) had endobronchial mass adherent to bronchial wall.BAL fungal culture yielded growth in 18(40.9%). TBLB yielded abnormal histopathology on 8(18.8%) patients. BAL showed mucormycosis in 14 (31.8%), MTB detected by CBNAAT in 8 (18.8%), aspergillosis in 8(18.8%) and candidiasis in 2(4.5%). During antifungal treatment, 12 (27.2%) died. Conclusion: After excluding ROCM, pulmonary mucormycosis followed by aspergillosis were the common fungal lung infections, in patients presenting to Pulmonary Medicine department of a tertiary care centre after recovery from COVID 19.