Invasive Fungal Sinusitis in Post COVID‐19 Patients: A New Clinical Entity

Abstract

Objectives Occurrence of invasive fungal respiratory superinfections in patients with COVID‐19 has gained increasing attention in the latest studies. Yet, description of acute invasive fungal sinusitis with its management in those patients is still scarce. This study aims to describe this recently increasing clinical entity in relation to COVID‐19 patients. Study Design Longitudinal prospective study. Methods Prospective longitudinal study included patients diagnosed with acute invasive fungal rhinosinusitis after a recent COVID‐19 infection. Antifungal agents given included amphotericin B, voriconazole, and/or posaconazole. Surgical treatment was restricted to patients with PCR negative results for COVID‐19. Endoscopic, open, and combined approaches were utilized to eradicate infection. Follow‐up for survived patients was maintained regularly for the first postoperative month. Results A total of 36 patients with a mean age of 52.92 ± 11.30 years old were included. Most common associated disease was diabetes mellitus (27.8%). Mycological analysis revealed infection with Mucor and Aspergillus species in 77.8% and 30.6% of patients, respectively. Sino‐nasal, orbital, cerebral, and palatine involvement was found in 100%, 80.6%, 27.8%, and 33.3% of patients, respectively. The most common reported symptoms and signs are facial pain (75%), facial numbness (66.7%), ophthalmoplegia, and visual loss (63.9%). All patients were treated simultaneously by surgical debridement with antifungal medications except for two patients with PCR‐positive swab for COVID‐19. These two patients received antifungal therapy alone. Overall survival rate was 63.89% (23/36). Conclusion Clinical suspicion of acute invasive fungal sinusitis among COVID‐19 patients and early management with antifungal therapy and surgical debridement is essential for better outcomes and higher survival. Level of Evidence IV Laryngoscope , 2021

Rhino-orbito-cerebral mucormycosis during the COVID-19 third wave in 2021: an Egyptian preliminary report from a single tertiary hospital

“…In Egypt at the Department of Otorhinolaryngology, Mansoura University, El-Kholy et al [ 57 ] reported a total of 36 patients with fungal rhinosinusitis (AIFR) in the last quarter of 2020 during the second wave of the pandemic. DM was the most common associated risk factor (27.8%).…”

Epidemiology and Pathophysiology of COVID-19-Associated Mucormycosis: India Versus the Rest of the World

“…We excluded five of these 39 citations, reporting on 2293 cases (3 citations from India [n = 2272], one each from Iran [n = 10], and Egypt [n = 11]), where individual patient details were not available. [25,33,36,37,44]. Finally, we included 275 reported cases of CAM, of which 233 were reported from India and 42 from the rest of the world (most commonly from Iran [n = 19], the USA [n = 9], and others).…”

COVID-19-Associated Mucormycosis (CAM): Case-Series and Global Analysis of Mortality Risk Factors

“…On analyzing the sources of the reported cases, India was the most contributing country (55.5%) [46][47][48][49][50]58,69,77,[80][81][82][84][85][86][87][88], followed by Egypt (17.8%) [72,74], Iran (9.9%) [63,64,70,78], Turkey (6.3%) [65,71], and the United States of America (4.7%) [52][53][54][55][56][57]59,75,76]. See Figure 4.…”