Covid-19-Related Acute Invasive Fungal Sinusitis: Clinical Features and Outcomes

Abstract

Introduction There is a noticeable increase in the incidence of acute invasive fungal sinusitis which coincides with the ongoing coronavirus pandemic. It is a potentially-lethal fungal infection, with the most common form being the rhino-orbito-cerebral presentation. Objectives The aim of the present study is to discuss the different epidemiological factors, risk factors, clinical presentations and outcomes of acute invasive fungal sinusitis which is noticeably related to the coronavirus disease 2019 (Covid-19) pandemic. Methods The present cross-sectional cohort study included 22 adult patients who presented with Covid-19-related acute invasive fungal sinusitis. The diagnosis of acute invasive fungal sinusitis was confirmed by histopathological biopsy. All data, including demographics, risk factors, clinical findings, different lines of treatment and their outcomes, were recorded and analyzed. Results All patients had diabetes mellitus (100%), and 17 (77.3%) had been submitted to systemic steroids. All patients (100%) had unilateral sinonasal disease. Proptosis was found in 15 patients (68.2%), ophthalmoplegia was observed in 12 patients (54.5%), and intracranial affection occurred in 10 patients (45.5%). A total of 20 patients (90.9%) received liposomal amphotericin B. Surgical debridement was performed in 18 patients (45.5%). Non-septated mycelia was present in 19 biopsies (86.4%), while 3 (13.6%)showed septated mycelia. Total improvement was achieved in 10 patients (45.5%), while the mortality rate was of 27.3% (6 out of 22 participants). Conclusion Diabetes mellitus is the most common preexisting medical condition associated with Covid-19-related acute invasive fungal sinusitis. Systemic corticosteroid therapy is considered a predisposing factor. It is necessary to raise the level of awareness to diagnose this condition, especially in patients with Covid-19 infection or those who have recently recovered from it.

Invasive Fungal Sinusitis During Active COVID-19 Infection

“…8 Invasive fungal sinusitis has also been shown to be more common in immunecompromised patients, such as those with diabetic, renal, and liver dysfunction. 5,9,10 Interestingly, there have been articles published on IFS in patients who recovered from COVID-19. On multivariate analysis, a history of COVID-19 infection was an independent risk factor when controlling for other comorbidities.…”

“… 8 Invasive fungal sinusitis has also been shown to be more common in immune-compromised patients, such as those with diabetic, renal, and liver dysfunction. 5 , 9 , 10 …”

SARS-CoV-2 Infection (COVID-19) and Rhinologic Manifestation: Narrative Review

“…According to the pathological results, mucormycosis was confirmed in 19 patients (86.4%) and aspergillus in only 3 patients (13.6%). The treatment outcome included total improvement in 10 patients (45.5%), intracranial extension in 10 patents (45.5%), and 6 patients died from the disease (the mortality rate was 27.3%) [ 37 ]. Dilek et al systematically reviewed COVID-19-associated mucormycosis in 100 patients.…”

“…To date, there have been many reports on the association between acute invasive fungal rhinosinusitis and COVID-19 infection [ 37 , 38 , 39 , 40 ]. Abdelsamie et al presented a cross-sectional cohort study of 22 adult COVID-19 patients with concomitantly confirmed acute invasive fungal rhinosinusitis.…”

“…The overall survival rate was approximately 66.7% [ 38 ]. According to these articles, the most common risk factors have been corticosteroid use and diabetes mellitus [ 37 , 38 ]. Immune suppression observed in COVID-19 patients was attributed to a decrease in CD4+ and CD8+ T cells [ 41 ].…”