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Sankara Nethralaya (JKCN Complex) is a eye care center and doctor located in Chennai, Tamil Nadu. The average rating of this place is 4.00 out of 5 stars based on 198 reviews. The street address of this place is Medical Research Foundation Shankar Nethralaya, 21, Pycrofts Garden Rd, off Haddows Road, Thousand Lights West, Gandhi Nagar, Chennai, Tamil Nadu 600006, India. It is about 0.59 kilometers away from the Nungambakkam railway station.

Thandava Moorthy 14 months ago Good hospital specialised for eyes. Doctors are very good and spoke to effective very politely. Rooms are very good and nurses also check patient proper timing and guide the patients to very well. Canteen also good affordable price for middle class family. Foods and serving people’s very hygienic.

Archita Sahu 11 months ago One star because of their Computer Vision unit. The computer vision unit in Chennai is a total scam. Be aware before going there. They sold me a software, for around 4K, saying that it will help me to relax the computer strain off my eyes. After coming home I realized that their software is not compatible to run on my laptop, which is a macbook. It seems that they made a software which is compatible only with windows and didn't bother to call out this limitation while selling it. I feel cheated and robbed at this place. I have been emailing and calling them to get a refund but their team is a bunch of scammers and liers who won't even reply. Please don't ever visit their computer vision clinic!

Azharul Islam kausar 57 months ago Indian top eye care hospital.. hospital very neat and clean. Very good Service.. Environment very nice. Doctor behavior 100% good.. Staff very good.

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Welcome to Sankara Nethralaya (Main Campus) - Chennai

Sankara Netralaya is a not-for-profit charitable hospital that was started with the idea of providing tertiary eye care to the people in the country. The hospital, which was started in 1978, has more than 80 eye care professionals who examine about 1500 patients and perform around 125 surgeries every day. Sankara Nethralaya lays a very strong emphasis on community service and one of the initiatives includes eye camps in rural areas and free surgeries to those with income of less than Rs 3500 per month. About 50 % of the Out-Patient Department and 35 % of the surgeries are done free of cost to the underprivileged. Sankara Nethralaya which offers both outpatient and inpatient services has a dedicated team of specialist ophthalmologists, nursing staff, administrative staff and support staff who ensure that all patients receive the best treatment. Sankara Nethralaya has various sub specialties such as cataract, cornea, glaucoma, neuro-ophthalmology, squint and pediatric ophthalmology, retina, uvea, oculoplasty, ocular oncology and refractive surgery. The Sankara Nethralaya Academy is the academic wing of Sankara Nethralaya which offers various types of educational programs ranging from certificate to doctoral level programs in various fields related to allied health sciences. Sankara Nethralaya Other Branches 1. Jagadguru Kanchi Sri Chandrasekarendra Saraswathi Nethra Nilayam (JKCN Complex) No. 21, Pycrofts Garden Road (off. Haddows Road), Chennai 600 006, Tamil Nadu, India. 2. Sankara Nethralaya, Jaslok Community Ophthalmic Center Dr. V.G. Appukutty Campus No.8, GST Road, St. Thomas Mount, Chennai – 600 016. 3. C.U.Shah Sankara Nethralaya No. 8, GST Road, St.Thomas Mount, Guindy, Chennai 600 016, Tamil Nadu, India. 4. Sankara Nethralaya Referral Laboratory No. 21, Pycrofts Garden Road (off. Haddows Road), 5th Floor, Chennai 600 006, Tamil Nadu, India. 5. Sankara Nethralaya R A Puram New No.30, Old No.73, Kamarajar Salai R A Puram, Chennai 600 028 6. Smt. T.K. Lakshmi Ammal and Smt. T.K. Alamelu Ammal Sankara Nethralaya New No. 39, old no. 19, 1st Main Road, East Shenoy Nagar, Chennai 600 030. 7. Suraj Sankara Nethralaya No. 34, Dharmaraja Koil Street, Chetpet Post & Taluk, Tiruvannamalai Dt, Pincode 606801, Tamil Nadu, India. 8. SANKARA NETHRALAYA (ABSN), KOLKATA 147/1, Mukundapur, E.M. Bypass, Kolkata – 700 099, India 9. SANKARA NETHRALAYA(KBSN), NEWTOWN Plot No – DJ - 16, Premises No: 25-3333, Action Area – 1D, New Town, Kolkata - 700 156, India 10. SANKARA NETHRALAYA , RSM SQUARE No. 10, Raja Subodh Mullick Square, Kolkata - 700 013, India Ph. No. (033) 6657 6000 11. Sri City Sankara Nethralaya (A Unit of Medical Research Foundation, Chennai) Sri City Medical Care Center 305, North, 2nd street, Sector3, Sri City, VaradaiahpalemMandal ChittoorDist, AP-517541

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Molecular detection and identification of fungal pathogens infections occurring in COVID-19 recovered patients

Affiliations.

• 1 Sankara Nethralaya Referral Laboratory, Medical Research Foundation, No: 21, Pycrofts Garden Road, Nungambakkam, Chennai, 600 006 India.
• 2 L&T Microbiology Research Centre, Medical Research Foundation, Chennai, 600 006 India.
• PMID: 36776382
• PMCID: PMC9898846
• DOI: 10.1007/s13337-022-00805-8

The major outbreak of Corona virus disease COVID-19 caused by SARS-CoV-2 had brought about 4.55 million deaths and had shaken the health care system all over the world. From the year 2020 the recovered COVID-19 patients had started to develop microbial infection, most predominantly fungal infection in which Mucormycosis gained immediate attention as it has worsen the mortality rate in humans. In the present study of 53 COVID-19 recovered patients presented with microbial infection, the analysis of frequency distribution of fungal infection preponderantly with Rhizopus oryzae , followed by Aspergillus and Candida species.

Keywords: COVID recovered patients; Microbial infection; Molecular detection.

© The Author(s), under exclusive licence to Indian Virological Society 2023.

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Molecular detection and identification of fungal pathogens infections occurring in COVID-19 recovered patients

• Short Communication
• Published: 04 February 2023
• Volume 34 , pages 88–91, ( 2023 )

Cite this article

• Dhanurekha Lakshmipathy   ORCID: orcid.org/0000-0002-8550-1415 1 ,
• Anand Appakudal Ramaswamy 2 ,
• Hema Raja Pushpam Maharajan 1 ,
• Revathy Menon Anand 1 ,
• Aishwariya Thangam 1 &
• Ranjith Kumar Santharaj 1  

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The major outbreak of Corona virus disease COVID-19 caused by SARS-CoV-2 had brought about 4.55 million deaths and had shaken the health care system all over the world. From the year 2020 the recovered COVID-19 patients had started to develop microbial infection, most predominantly fungal infection in which Mucormycosis gained immediate attention as it has worsen the mortality rate in humans. In the present study of 53 COVID-19 recovered patients presented with microbial infection, the analysis of frequency distribution of fungal infection preponderantly with Rhizopus oryzae , followed by Aspergillus and Candida species.

Avoid common mistakes on your manuscript.

Corona virus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) belongs to the member of enveloped RNA β-coronavirus has become a recent public health challenge all over the world [ 5 ]. COVID-19 causes severe pneumonia in both adults and children. The predisposing factors in acquiring microbial co-infection especially fungal aetiology in COVID-19 recovered cases could be due to broad-spectrum antibiotics with uncertain effectiveness, extended intubation, use of intrusive catheters, chronic respiratory diseases, corticosteroid treatment and immune inflammatory reaction [ 10 ]. Thus, fungal co-infection in COVID-19 recovered cases is very critical and may raise difficulties in diagnosis, treatment, prognosis of COVID-19 and moreover the microbial co-infection could be a significant promoter to the final mortality in COVID-19 patients [ 10 ]. Laboratory diagnosis of fungus aetiology include direct smear microscopy which may lack sensitivity and conventional culture isolation needs longer incubation period for identification of the fungal pathogen. Therefore, an early diagnosis of fungal co infection in COVID-19 cases is crucial for rapid and accurate treatment in COVID-19 recovered patients.

The study was carried out after obtaining approval from Institutional Research and Ethical board (IRB). The present study was a retrospective study. The clinical samples received for Panfungal PCR and sequencing from mucormycosis suspected COVID-19 recovered patients were set as inclusion criteria for the study and mucormycosis cases with no history of COVID-19 were excluded from the present study. A total of 53 tissue samples (nasal cavity-8, Paranasal sinus-13, nasal meatus-2, sino nasal tissue-5, nasal tissue-25) received for molecular diagnostics during the month of April to September 2021 when the second wave of COVID-19 infection at its peak were retrospectively analyzed in this study.

All the 53 clinical specimens were subjected to DNA extraction using Qiagen DNA extraction mini kit (Hilden, Germany) according to the manufacturer’s instructions. The PCR targeting ITS region of panfungal genome and DNA sequencing was carried out using primers and thermal profile published by Bhagyalakshmi etal [ 2 ]. Further, the COVID-19 fungal co infection data were analysed in Graph pad Prism version 9.2 to determine the frequency and percentage of infection [ 6 ] among the study population and to correlate with the age group.

Among 53 tissue samples from COVID-19 recovered patients analyzed in this study, 42 were positive for PCR targeting ITS region of panfungal genome and remaining 11 were negative. The most common fungal pathogen identified in the present study were Rhizopus oryzae (31) followed by Aspergillus species (4) Candida species (4) Cladosporium species (1) and Saksenaea trapezispora (1). The detailed fungal pathogens identified in the present study were given in Table 1 .

The Frequency distribution analysis was performed with the ages of COVID-19 recovered patients ranging from 29 to 80 years in male and 36 to 75 years in female with mean age of 51 years in male and 56 years in female. The analysis showed that male and female population aging between 50–70 years and 70–80 years respectively were most vulnerable age group affected with fungal infection in COVID-19 recovered cases (Fig.  1 ). With regard to the fungal co infection in COVID-19 recovered cases, male population aging between 50 and 60 years were relatively more prone to fungal infection than females. Apparently the Percentage of infection among males were 62% and in females were 15% (Fig. 2 ).

Frequency distribution of post COVID-19 fungal infection among male and female

Percentage comparison of male and female with suspected post COVID-19 fungal infection cases

Microbial co-infection could be an important cause of life-threatening infection in COVID-19 recovered patients due to high risk factors such as patients on ventilators in intensive care units for several days, development of drug resistance during treatment which may result in reduced number of lymphocytes in COVID-19 infected patients and hence patients become more prone to opportunistic fungal or bacterial infections [ 9 ]. Moreover, administration of steroid drugs in 80% of the current population in the study and glucocorticoids in COVID-19 treatment, which further devitalize their immunity making the patients more vulnerable to fungal infections than bacterial infections.

To date, there are only limited studies investigated on microbial co infection in COVID-19 recovered patients and most of the data were not available about the profile of microorganism involved [ 1 ]. Chen et al [ 3 ] from China reported on difficulty in distinguishing bacterial or fungal infection existing with viral pneumonia based on clinical and radiological performance and found fungal DNA sequencing would be a more reliable method to identify and diagnose the fungal co infection and the authors had also reported the prevalence rate of 3% Candida albicans , 1% Aspergillus flavus and Candida glabrata co infection in 99 COVID-19 cases. Yang et al. [ 12 ] found that 5.8% patients had Aspergillus flavus , Aspergillus fumigatus and Candida albicans co-infection in 52 critically ill SARS-CoV-2 pneumonia patients.

The present study was aimed to detect and identify fungal pathogens in COVID-19 recovered patients by PCR based DNA sequencing targeting ITS region. In our study, 77.5% cases had fungal coinfection in COVID-19 recovered cases. The most frequently detected fungal pathogen were Rhizopus oryzae (58%), followed by Aspergillus species (6.8%) and Candida species (5.1%). The dominance of Rhizopus oryzae co-infection in COVID-19 recovered patients could be due to their natural tendency to grow in an indoor environments. As most COVID-19 patients were hospitalized and underwent a surgical procedure to remove the infected tissue and hence it is more frequent to contract Rhizopus oryzae co infection even after recovery. In contrast, a similar study performed in Nottingham University, Uk reported that European Countries were more prone to Invasive Aspergillosis associated with SARS or viral pneumoniae or influenza infection [ 8 ] and Pneumocystis jirovecii  co infection in African countries [ 4 ].

Interestingly 88% of the patients in the present study had previous history of maxillary sinusitis or rhino sinusitis. So the inflammation in maxillary sinus region served as a room for the fungus to grow and the patients would have undergone Functional Endoscopic Sinus Surgery to remove the affected tissue. Reasonable number of patients diagnosed with chronic rhino sinusitis often had a final diagnosis of fungal sinusitis were also reported elsewhere [ 7 , 11 ]. In our study we could observe the significant incidence of Sino nasal mucormycosis as comorbid existence of rhino sinusitis or sinusitis (88%) and in Diabetic Mellitus cases (4.8%). The remaining diabetic status of the study population were not available. In this current study the Frequency Distribution analysis was performed with the ages of COVID-19 recovered patients ranging from 29 to 80 years in males and 36–75 years in females with mean age of 51 years in male and 56 years in female. From the analysis it was found that male and female population aging between 50–70 years and 70–80 years respectively were most vulnerable age group affected with fungal infection in COVID-19 recovered patients. Male population belonging to all age categories ranging from 25 to 80 years were infected with fungus after COVID-19 recovery. Whereas the female population at the age above 35 years were infected with both bacterial and fungal and the infection rate was higher in older age group. The median age group was 52, 62 years in male and female respectively. This shows that male population were affected irrespective of age whereas female population were more frequently affected only above 60 years of age with Relative frequency of 35%.

Our study had limitations. In the present study, we have identified only the fungal pathogens causing co infection in COVID-19 recovered cases. The other microbial infections caused by bacterial or viral or parasites associated with COVID-19 needs to be explored to study the overall microbial co-infection in COVID-19 recovered patients. In the present study, we also attempted for fungal isolation, but culture does not revealed growth except in 2 ( R. oryzae ) clinical specimens. This could be due to the loss of viability of the fungus in the specimen during transportation or due to the administration of antimicrobials to the patients prior to sample collection. Another limitation in our study was non availability of complete clinical history and the treatment outcomes for all the patients which resulted in lack of clinical interpretation and correlation with our Laboratory results. To conclude, our findings supports the need for rapid and reliable diagnostic tool to identify the fungal pathogens within 1–2 days and to appropriately treat co-occurring fungal infections among patients with COVID-19 infection.

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The authors would like to thank Medical Research foundation for supporting the study.

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Dhanurekha Lakshmipathy, Hema Raja Pushpam Maharajan, Revathy Menon Anand, Aishwariya Thangam & Ranjith Kumar Santharaj

L&T Microbiology Research Centre, Medical Research Foundation, Chennai, 600 006, India

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Lakshmipathy, D., Appakudal Ramaswamy, A., Maharajan, H.R.P. et al. Molecular detection and identification of fungal pathogens infections occurring in COVID-19 recovered patients. VirusDis. 34 , 88–91 (2023). https://doi.org/10.1007/s13337-022-00805-8

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Received : 25 February 2022

Accepted : 26 December 2022

Published : 04 February 2023

Issue Date : March 2023

DOI : https://doi.org/10.1007/s13337-022-00805-8

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