Dear Editor,
Mucormycosis has recently emerged as one of the most serious complications of COVID-19 [1]. Over the months of May and June 2021, our Mycology team provided diagnosis to approximately 600 suspected cases of mucormycosis [2,3]. Several measures were put in place to ensure early and accurate diagnosis. These included:
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Formation of an emergency team for the laboratory: Laboratory technicians and residents with at least 6 months experience in Mycology were part of the diagnostic team. For the safety of the team a security guard was posted near the laboratory at all times.
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Round-the-clock services for examination and processing of samples from cases of suspected mucormycosis: The use of calcofluor white-KOH based fluorescence microscopy in our laboratory greatly increases the sensitivity of direct microscopy as a rapid and reliable method (Fig. 1 ).
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Adding new culture media for better recovery of Mucorales: In addition to the routine culture media, we added the Dicloran Rose Bengal Chloramphenicol medium (DRBC) with benomyl media for better recovery of Mucorales as this medium inhibits growth of many yeasts and other moulds [4].
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‘Critical alert system’ & Robust clinical advisory services: All direct microscopy reports indicating mucormycosis were informed telephonically to the clinical JR/SR for the respective patients and uploaded online for easy access, within 2–3 hours of receiving the sample in the laboratory.
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Introduction of molecular methods for diagnosis of mucormycosis: Two real-time PCR assays, one developed in-house and one commercial kit (Mucorgenius™ by Pathonostics, The Netherlands) [5] were introduced for diagnosis of cases where conventional methods were inconclusive with strong clinical suspicion.
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Therapeutic drug monitoring for posaconazole: Measurement of serum posaconazole levels by bioassay was performed as required for all mucormycosis patients receiving posaconazole, either as primary treatment due to a contra-indication to amphotericin B, or as step-down treatment after completing a full course of amphotericin B.
Fig. 1.
KOH-Calcofluor white mount showing broad aseptate hyphae with ribbon-like folding in a biopsy specimen.
Funding
None.
Ethical approval
The study was approved by the Institute Ethics Committee vide reference number: IEC-401/02.07.2021, RP-26/2021, dated 19.07.2021.
Declaration of competing interest
None.
Acknowledgements
None.
References
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- 5.MucorGenius® | PathoNostics [Internet] https://www.pathonostics.com/product/mucorgenius [cited 2021]. Available from: