Invasive Fungal Sinusitis in Post-COVID-19 Patients with Diabetes Mellitus.

Abstract

Invasive fungal sinusitis is an invasive disease associated with high mortality of up to 60%. There is a well-documented increase in rhino-orbital-cerebral fungal co-infection in COVID-19 patients. Our study aimed to determine the factors that lead to the development, the natural history of progression and the therapeutic interventions done for this grave complication. Patients admitted in general medicine ward in King Edward Memorial (KEM) Hospital, Mumbai were included. Patient's history and examination findings were noted. Advised Investigations- imaging studies like CT scan, MRI done were noted down. Operative procedures like functional endoscopic sinus surgery (FESS), abscess drainage, dental extraction, were performed at the hospital and details were taken. Fungal cultures, sugar monitoring, liver function test, renal function test, complete blood counts, ECGs, chest X-rays, and amphotericin charting were also done.. On retrospective analysis of the presenting patient's records, we found that all patients had received steroids for COVID-19 treatment and had co-morbidities, especially diabetes mellitus. Prolonged hospitalization further exposes the patient to various multi-resistant bacteria making them prone to various secondary infections. It is of paramount importance that physicians know the associated risk factors, mentioned in our study, that may lead to invasive fungal co-infection in COVID-19 patients, and to regularly examine the patient for any developing signs so appropriate diagnosis and treatment can be initiated as early as possible. It is an unrelenting disease process that requires the utmost care, and our case series provides an in depth look of four such cases for future reference.