Changing faces and habitat of mucormycosis epidemic in sequential COVID waves

The Corona virus poses a greater challenge in the form of the deadly fungal infection, mucormycosis. To study the histopathological features giving emphasis on the varying presentation of mucormycosis in sequential covid waves.A prospective study comprising 31 patients histopathologically diagnosed with mucormycosis were included in the study. Demographic features, predisposing conditions, and clinical features were obtained from medical records. Tissue sections were reviewed with hematoxylin and eosin (H and E), and special stains like Gomori's methenamine silver (GMS), and periodic acid Schiff (PAS) potassium hydroxide (KOH) examination and fungal culture. The study included 21 males and 10 females with age ranging from 35-75 years. On histopathological examination, inflammation, granulomas, foreign body giant cells along with necrosis was seen. Invasion into soft tissues, muscles, and adipose tissues along with Angioinvasion, perineural spread was identified. Fungal balls, round to ovoid mature sporangia with column-shaped columella, presence of proliferating hyphae in tissues like skeletal muscle, cartilage etc which are supposed to be relatively resistant for inflammatory pathology got noted as one of our astounded histopathological findings insinuating how a human body acts as a culture media exhibiting diversity of a human makeup. The trend of presentation and severity kept changing with successive covid wave. Diagnosis of mucormycosis is gruesome and more difficult as compared to other infectious organism. In addition, like any malignant pathology, perivascular and neural infiltration is one of the important histological features of invasive mucormycosis as it indicates the severity and prognosis. There is drastically different trend of presentation in covid and its different mutant waves.