COVID-19-Associated Rhino-Orbital Mucormycosis: Histological and Electron Microscopy Characteristics
Ionuț Isaia Jeican,
Delia Ioana Horhat,
Mihai Dumitru,
Adrian Florea,
Lucian Barbu-Tudoran,
Bogdan-Alexandru Gheban,
Vlad Anton,
Corneliu Toader,
Maria Aluaș,
Costel Vasile Siserman,
Nicolae Balica,
Daniela Vrînceanu,
Silviu Albu
Affiliations
Ionuț Isaia Jeican
Department of Anatomy and Embryology, Iuliu Hatieganu University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
Delia Ioana Horhat
Department of Ear-Nose-Throat, Victor Babes University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
Mihai Dumitru
Department of Ear-Nose-Throat, Carol Davila University of Medicine and Pharmacy, 050472 Bucharest, Romania
Adrian Florea
Department of Cell and Molecular Biology, Iuliu Hatieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania
Lucian Barbu-Tudoran
Electron Microscopy Laboratory Prof. C. Crăciun, Faculty of Biology and Geology, Babes-Bolyai University, 400006 Cluj-Napoca, Romania
Bogdan-Alexandru Gheban
Department of Histology, Iuliu Hatieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania
Vlad Anton
Department of Medical Biochemistry, Iuliu Hatieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania
Corneliu Toader
Clinic of Neurosurgery, National Institute of Neurology and Neurovascular Diseases, 041914 Bucharest, Romania
Maria Aluaș
Department of Oral Health, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
Costel Vasile Siserman
Institute of Legal Medicine, 400006 Cluj-Napoca, Romania
Nicolae Balica
Department of Ear-Nose-Throat, Victor Babes University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
Daniela Vrînceanu
Department of Ear-Nose-Throat, Carol Davila University of Medicine and Pharmacy, 050472 Bucharest, Romania
Silviu Albu
Department of Head and Neck Surgery and Otorhinolaryngology, University Clinical Hospital of Railway Company, Iuliu Hatieganu University of Medicine and Pharmacy, 400015 Cluj-Napoca, Romania
COVID-19-associated rhino-orbital mucormycosis has become a new clinical entity. This study’s aim was to evaluate the histopathological and ultramicroscopic morphological aspects of this fungal infection. This was an observational retrospective study on eight patients from three tertiary centers in Romania. The tissue samples collected during functional endoscopic sinus surgery were studied through histopathological examination, scanning electron microscopy, and transmission electron microscopy. In the histopathological examination, the morphological aspects characteristic of mucormycosis in all cases were identified: wide aseptate hyphae with right-angle ramifications, which invade blood vessels. One case presented perineural invasion into the perineural lymphatics. And in another case, mucormycosis–aspergillosis fungal coinfection was identified. Through scanning electron microscopy, long hyphae on the surface of the mucosa surrounded by cells belonging to the local immune system were identified in all samples, and bacterial biofilms were identified in half of the samples. Through transmission electron microscopy, aseptate hyphae and bacterial elements were identified in the majority of the samples. Rhino-orbital-cerebral mucormycosis associated with COVID-19 produces nasal sinus dysbiosis, which favors the appearance of bacterial biofilms. The way in which the infection develops depends on the interaction of the fungi with cells of the immune system.
