The Spectrum of Invasive Fungal Sinusitis in COVID-19 Patients: Experience from a Tertiary Care Referral Center in Northern India.

Surendra Singh Baghel,Radha Krishan Dhiman,Prabhakar Mishra,Arulalan Mathialagan,Raj Kumar,Ravi Sankar Manogaran,Abhishek Kumar Dubey,Arun Kumar Srivastava,Pawan Kumar Verma,Amit Kumar Keshri,Rungmei Marak,Govind Bhuskute

doi:10.3390/jof8030223

Abstract

This study aimed to determine the patient demographics, risk factors, which include comorbidities, medications used to treat COVID-19, and presenting symptoms and signs, and the management outcome of COVID-19-associated invasive fungal sinusitis. A retrospective, propensity score-matched, comparative study was conducted at a tertiary care center, involving 124 patients with invasive fungal sinusitis admitted between April 2021 and September 2021, suffering from or having a history of COVID-19 infection. Among the 124 patients, 87 were male, and 37 were female. A total of 72.6% of patients received steroids, while 73.4% received antibiotics, and 55.6% received oxygen during COVID-19 management. The most common comorbidities were diabetes mellitus (83.9%) and hypertension (30.6%). A total of 92.2% had mucor, 16.9% had aspergillus, 12.9% had both, and one patient had hyalohyphomycosis on fungal smear and culture. The comparative study showed the significant role of serum ferritin, glycemic control, steroid use, and duration in COVID-19-associated invasive fungal disease (p < 0.001). Headache and facial pain (68, 54.8%) were the most common symptoms. The most involved sinonasal site was the maxillary sinus (90, 72.6%). The overall survival rate at the three-month follow-up was 79.9%. COVID-19-related aggressive inflammatory response, uncontrolled glycemic level, and rampant use of steroids are the most important predisposing factors in developing COVID-19-associated invasive fungal sinusitis.

Highlights

Coronavirus disease 2019 (COVID-19) is an infection caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)
A total of 124 patients were diagnosed with invasive fungal sinusitis with a history of COVID-19 infection; of them, 87 were male, and 37 were female
Fungal sinusitis confirmation was performed by KOH mount, fungal culture, and histopathological examination

Summary

Introduction

Coronavirus disease 2019 (COVID-19) is an infection caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Since the first case was detected in December 2019 in Wuhan, China, there have been various twists and turns in the understanding of its pathophysiology, diagnosis, management, sequelae, and complications [1]. COVID-19 has been associated with a wide range of opportunistic infections [2]. Recent observations have revealed a dangerous and potentially deadly complication, invasive fungal sinusitis, resulting from mucormycosis. Sinonasal mucormycosis is a life-threatening invasive fungal sinusitis that typically affects immunocompromised individuals. The highrisk groups are those with uncontrolled diabetes mellitus, acquired immunodeficiency syndrome, iatrogenic immunosuppression, and hematologic malignancies, and those who have undergone organ transplantation [3,4,5]

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