Clinico-mycological profile and antifungal susceptibility patterns of zygomycosis during the COVID-19 pandemic at a tertiary care center

• Author Details:   
• Sinduja Subramaniyan ^*
• Anupma Jyoti Kindo
• Prasanna Kumar Saravanam

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Background: Zygomycosis has emerged as a significant opportunistic fungal infection, with a marked increase in incidence during the COVID-19 pandemic, particularly among immunocompromised individuals such as those with diabetes mellitus.

Aim: To analyze the clinico-mycological profile of zygomycosis and determine the antifungal susceptibility patterns, including the minimum inhibitory concentrations (MICs) of commonly used antifungal agents.

Materials and Methods: A total of 57 culture-positive clinical isolates suspected of zygomycosis were included. Specimens were collected from paranasal sinuses, bronchoalveolar lavage, bronchial wash, wounds, nasal swabs, and lung and brain tissues. Identification was done via culture, microscopy, and gene sequencing. Antifungal susceptibility testing for itraconazole, posaconazole, voriconazole, and amphotericin B was performed using the CLSI M38-A2 broth microdilution method.

Results: Rhizopus spp. was the predominant isolate (83%), followed by Apophysomyces variabilis (7%), Lichtheimia corymbifera (7%), and Cunninghamella bertholletiae (2%). Amphotericin B showed the highest efficacy among the studied antifungal agents, followed by posaconazole. Itraconazole and voriconazole was largely ineffective.

Conclusion: Zygomycosis continues to be a life-threatening infection, especially in patients with diabetes and a history of COVID-19. Rhizopus spp. remains the most common etiological agent. Amphotericin B and posaconazole are the antifungal agents deemed most likely to be effective, underlining the importance of routine susceptibility testing for optimized treatment outcomes.