Background: Mucormycosis is an angio-invasive infection, caused by ubiquitous environmental fungal species of the order Mucorales including Rhizopus, Lichtheimia, Mucor, and Rhizomucor species. The clinical presentation of mucormycosis varies according to the anatomical site of involvement. The incidence rate of mucormycosis globally varies from 0.005 to 1.7 per million population. India’s yearly prevalence of CAM is around 0.02-9.5 cases per 100,000 people. COVID -19 associated mucormycosis was mostly isolated during the second wave with mortality of 31-50%. Objective: To identify the outcome of early diagnosis and initiation of antifungal treatment in CAM-associated mortality and morbidity. Material& Methods: A study was done at IGMC Shimla over a period of 8 months (May 2021 to December 2022). All hospitalized patients diagnosed with COVID-19 and with suspected mucormycosis were included in the study. Biopsy/scrapings of affected area were collected and received at Microbiology department. Samples were subjected to direct microscopy using 10%/20% KOH for fungal elements and cultured on Sabouraud’s dextrose agar with chloramphenicol and cycloheximide at 25o and 370C. The fungal diagnosis was done by LCB mount. Results: A total of 913 cases of covid-19 were admitted in the isolation unit during this period out of which 62(6.8%) were suspected of mucormycosis. Samples were sent for processing. KOH positive in 14% and 18% were culture positive. Rhizopus (84%) and Lichtheimia (7%) species were found. Patients affected were mainly in the 5th (15%) and 6th (38%) decade of life. Results identified diabetes (76%) as the primary predisposing factor. Other comorbidities like hypertension (15%) and hepatitis C virus (15%) were also found in CAM cases. Rhino-orbital-cerebral infection was most common with involvement of nasal mucosa (69%), palate (15%), brain (7%) and orbit (15%). Initiation of antifungal therapy improved outcome in CAM. Overall mortality observed in COVID-associated mucormycosis was 32%. Conclusion: CAM could be avoided by early diagnosis, identifying high-risk groups and managing uncontrolled diabetes. All these factors would help the clinicians to decrease mortality and morbidity in CAM.

Fungal infections have emerged as a worldwide healthcare problem in recent years due to extensive use of broad spectrum antibiotics, long term use of immunosuppressive agents, increased use of indwelling devices and increasing population of terminally ill, debilitated and immune-compromised patients. The local patterns of fungal isolates from clinical specimen may change with time and geographical area and it is important to be familiar with recent local trends in order to improve patient management, hence the need for surveillance. Aim of Study: To study the spectrum of fungal isolates from clinical Specimens in a Tertiary Care Hospital in Sub-Himalayan Region. Material and Methods: Retrospective study was done at Indira Gandhi Medical College, Shimla from July 2021-June 2022. Samples received in mycology laboratory were processed using direct microscopy with 10%, 20% and 40% potassium hydroxide (KOH), India ink and Gram staining to visualize the presence of fungal elements. All the samples were inoculated on Sabouraud’s dextrose agar (SDA) one with chloramphenicol and other with cycloheximide, then further incubated at 250 and 370 C. Result: Of the 752 clinical samples 273 (36%) had fungal growth, 300 (40%) were contaminants and 179 (24%) showed no growth. Among the respiratory samples (369), 121 samples (33%) were positive in fungal culture. The other major samples received were skin scrapings (81), skin biopsy (56) and oral mucosal scrapings (25) in which fungal growth was observed in 28 (35%), 21 (38%) and 17 (68%) respectively. Most common isolate observed among dermatophytes was T.mentagrophytes 15 (71%) followed by T.rubrum 3 (14%) and T.violaceum 2 (10%). Sporothrix schenckii 16 (57%) was predominant in patients suspected of subcutaneous mycosis.Candida albicans 41 (87%) was isolated in reproductive age group females followed by Candida glabrata 4 (9%) and Candida tropicalis 2 (4%).In corneal scrapings, growth of Fusarium 4 (27%), Cladosporium 4 (27%) and Aspergillus fumigatus 3 (20%) was obtained. Conclusion: Predominant fungal isolate incriminated in superficial fungal infections was T.mentagrophytes followed by T.rubrum and T.violaceum.Sporothrix schenckii was the major isolate in patients suspected of subcutaneous mycosis.Candida albicans was the most common isolate in reproductive age group females followed by Candida glabrata and Candida tropicalis. In corneal scrapings, different fungal pathogens were Fusarium , Cladosporium and Aspergillus fumigatus.