Acute invasive fungal sinusitis is an aggressive infection affecting immunocomprosmised patients and carries a high mortality. Patients with Covid-pneumonia are at an increased risk of developing invasive pulmonary fungal infections probably due to their reduced immunological competence. Here, we review three cases of Covid-associated invasive fungal sinusitis.

Background Tuberculosis (TB) of the middle ear cleft (MEC) is a rare extra-pulmonary manifestation. Signs and symptoms of tuberculous otitis media are indistinguishable from that of non-tuberculous otitis media making early diagnosis difficult. Objectives To study the clinical presentations, complications and effective diagnostic modalities in tuberculosis of middle ear cleft. Methods We retrospectively studied 10 patients diagnosed with chronic otitis media, unresponsive to 2 months conventional treatment. Pure tone audiogram, High resolution computed tomography (HRCT) of temporal bone, and AFB staining of ear discharge were done. All patients underwent mastoid surgery. AFB staining and histopathological examination of granulation tissue removed from the middle ear and mastoid were also done. Results Clinical findings were mastoid swelling, facial palsy and post-aural fistula 3,4 & 2 patients respectively. All patients had persistent ear discharge and three had vertigo. Hearing loss was of moderate conductive type in five, sensorineural type in three and mixed type in two. HRCT of temporal bone revealed soft tissue density in MEC in 9 and evidence of bone destruction in 6 cases. Diagnosis of TB was confirmed either by (a) demonstration of AFB in ear discharge (4 patients)/tissue removed during surgery (4 patients) or (b) by demonstration of tuberculous granulomas with necrosis on histopathological examination of tissue from MEC (8 patients). Conclusion Tuberculosis should be suspected in all cases of chronic otitis media unresponsive to conventional treatment particularly in endemic areas. Histopathological examination and AFB staining of tissue removed during mastoid surgery are reliable diagnostic methods.

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Purpose To compare the clinical profile of COVID-related and non-COVID-related rhino-orbito-cerebral invasive fungal disease. Methods We have compared the comorbidities, clinical features, course of the disease and outcome between COVID-related and non-COVID-related acute invasive fungal rhinosinusitis (AIFRS) of the rhino-orbito-cerebral form. Results HbA1c and blood sugar at the time of admission were significantly higher in the non-COVID group ( P < 0.05). Duration of stay, and use of steroids were significantly higher among the COVID group ( P < 0.05). The period of hospital stay was significantly higher in the COVID group. The overall survival in the COVID group was 67.57%. In the non-COVID group the overall survival was 61.90%.This study found that odds of surgical treatment was significantly lower among non-survivors ( P < 0.05). Similarly patients who developed stages 3 & 4 of the disease had a lower survival rate ( P < 0.05). Conclusion Diabetes mellitus is a key risk factor for the development of AIFRS. Pre-existing, grossly uncontrolled DM was the predisposing factor in the non-COVID group. Deranged glucose profile associated with COVID illness and its treatment and immunological disturbances in a vulnerable population, contributed to the surge in cases of AIFRS in the COVID-19-related group. Patients who underwent combined medical and surgical treatment had a significantly better outcome following AIFRS.

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