Version 2: Ramification of COVID-19 pandemic: Occurrence and impact of fungal Infections in a tertiary care hospital

Coronavirus disease 2019 (COVID-19) pandemic has been prevailing for more than a year associated with increased number of opportunistic invasive fungal infections in patients who have been critically ill or immunocompromised. In this retrospective study, details of various clinical specimens received from suspected patients of fungal infections were studied. The fungal infections were present in 64% (51/79) COVID-19 positive patients and 43% (163/381) COVID-19 negative patients during the year 2021 in the second wave of COVID-19. Among COVID-19 infected patients, the fungal infections mostly observed were candidiasis (63%) followed by aspergillosis (15% ) and mucormycosis (6%). The maximum samples (17% - COVID-19 positive and 83% - COVID-19 negative patients) which had shown positive results in COVID-19 infected patients were urine followed by serum (for aspergillus galactomannan). The candida infection was seen in 27% (21/79) urine and 15%(12/79) respiratory samples (BAL, tracheal aspirate, sputum) in COVID-19 positive patients. Mucormycosis with Rhizopus arrhizus and Rhizopus homothallicus isolations in nasal samples and tissue samples was observed in 6% COVID-19 positive patients. There has been an overall increase in fungal co-infections (candidiasis, aspergillosis and mucormycosis) during the COVID-19 pandemic (64% in COVID-19 positive and 43% in COVID-19 negative patients) which is a matter of great concern. Early diagnosis is essential for the effective management of these patients.