Acute Invasive Fungal Rhinosinusitis Research Articles

Clearing the Air: Acute Invasive Fungal Rhinosinusitis in Hematologic Cancer Patients.

Air quality has been shown to impact the rates of fungal infection of the airway, causing diseases such as acute invasive fungal rhinosinusitis (AIFRS), particularly in immunocompromised patients. We theorize that patients with hematologic malignancies in units with aging air handling units (AHUs) have a higher attack rate of AIFRS. Retrospective chart review identified patients with hematologic malignancy and AIFRS in two distinct and equal time periods between 2013 and 2022, representing the presence of aging AHUs and new AHUs, respectively. Cubic feet per minute (CFM) air flows, AIFRS attack rates, and clinical data were compared between the two groups and statistical analyses performed. The older AHUs produce air flow of 27,610 CFM and the newer AHUs produce air flow of 80,000 CFM. There were 18 patients with air supplied by older AHUs and 7 patients with air supplied by new AHUs who developed AIFRS. There was a significantly higher AIFRS attack rate for patients supplied by the older AHUs compared with patients supplied by newer AHUs (p = 0.033). The patients supplied by the older AHUs tended to be younger. The white blood cell counts, absolute neutrophil counts, and the mean time to diagnosis did not differ between the two groups. To our knowledge, this is the first study to examine AIFRS in immunocompromised patients' inpatient environment. Further research should explore whether higher CFM AHUs can decrease this disease among our most vulnerable patients. 3 Laryngoscope, 134:4466-4470, 2024.

Outcomes in Hematologic Malignancy Patients with Acute Invasive Fungal Rhinosinusitis

Outcomes in Hematologic Malignancy Patients with Acute Invasive Fungal Rhinosinusitis

Nasal Septum Deviation in Patients with Acute Invasive Fungal Rhinosinusitis in a Tertiary Care Hospital: A Cross-Sectional Study.

This is a retrospective study exploring the demographics and the role of nasal septum deviation in acute invasive fungal rhinosinusitis (AIFS); and if this deviation contributes to the laterality predilection of this opportunistic infection. Fifty-six craniofacial CT scans were evaluated by two radiologists blinded to the clinical data and outcome for laterality of the disease; and nasal septal deviation (NSD). NSD was graded based on the measured septal angle of deviation into mild, moderate, and severe and furtherly classified into one of seven types based on Mladina's classification. High prevalence of remarkable nasal septum deviation existed in our population with AIFS, with type 7 Mldina NSD represented the most prevalent in this population. We found no significant statistical relation between the side of deviation and the initial side of the fungal disease. We recommend screening for early manifestations of AIFS in similar debilitated patients; with high degrees of nasal septum deviation for considering it as an anatomical risk factor.

Mortality of Mucormycosis during Coronavirus Disease Pandemic

Abstract Background: Acute invasive fungal rhinosinusitis is an aggressive, mutilating, and in many cases life-threatening infection that results in rapid devitalization of tissues in the area of the nasal cavity and paranasal sinuses. Diabetic ketoacidosis, renal impairment, and hematological malignancies used to be the main predisposing factors for this serious infection. During the second wave of the pandemic of coronavirus disease (COVID-19), there has been an increment in these cases, in a manner that has not been witnessed before, and hence the interest in studying this topic. Objectives: Review of management outcomes and mortality in patients diagnosed with “possible invasive fungal rhinosinusitis” during the 2nd wave of COVID-19 pandemic and compare these with the outcomes observed before the pandemic in Iraq and other countries. Materials and Methods: A cross-sectional study of all patients with clinically possible invasive fungal rhinosinusitis (30 patients) presenting or referred to the ear nose and throat outpatient unit during the period from June 1st 2021 to December 31st 2021. Results: 30 patients were included, 53.3% male, 73.33% had mucormycosis following COVID-19 infection. Diabetes was the underlying condition in 57.67% of the cases. Fever, facial pain, nasal obstruction and headache were the most prevalent symptoms at presentation. The mortality rate was 16.7%. Conclusion: A reduced mortality rate was observed despite the increased number of cases, and this is mostly related to the early initiation of antifungal therapy.

Impact of azole antifungal treatment on outcome in acute invasive fungal rhinosinusitis with orbitocranial involvement: a surgical perspective.

To provide real-life data on azole treatment outcomes and the role of surgery in the current management of invasive fungal rhinosinusitis complicated by orbitocranial fungal infection (OCFI). Data was collected retrospectively from a chart review from four participating centers and a systematic literature review. The study group included patients with OCFI treated with azole antifungals. The control cases were treated with other antifungal agents. The cranial and orbital involvement degree was staged based on the imaging. The extent of the surgical resection was also classified to allow for inter-group comparison. There were 125 patients in the azole-treated group and 153 in the control group. Among the patients with OCFI cranial extension, 23% were operated on in the azole-treated group and 18% in the control group. However, meninges and brain resection were performed only in the controls (11% of patients) and never in the azole antifungals group. Orbital involvement required surgery in 26% of azole-treated cases and 39% of controls. Despite a more aggressive cranial involvement, azole-treated patients' mortality was significantly lower than in controls, with an OCFI-specific mortality rate of 21% vs. 52%. A similar, though not statistically significant, trend was found for the extent of the orbital disease and surgery. Despite less aggressive surgical intervention for cranial involvement, OCFI patients treated with azoles had a higher survival rate. This finding suggests we may improve morbidity with a more conservative surgical approach in conjunction with azole treatment. The same trend is emerging for orbital involvement.

РОЛЬ МСКТ И МРТ В ДИФФЕРЕНЦИАЛЬНОЙ ДИАГНОСТИКЕ ОСЛОЖНЕНИЙ СРЕДНЕЙ ЗОНЫ ЛИЦА У ПАЦИЕНТОВ С ПАТОЛОГИЕЙ ГРИБКОВОЙ ЭТИОЛОГИИ

Abstract. Introduction. Fungi are one of the constituents of an ecosystem. There are about 250 known human- pathogenic fungi species: From the widely spread Candida to the pathogene of aspergillosis that may lead to fatal consequences in certain conditions. Studies performed by Russian and foreign authors show the increase in the frequency of chronic sinusitis determined by the presence of fungi or fungal-microbial associations. Aim of this study is to perform the differential diagnosis of midface complications in patients with fungal pathology according to multispiral computed tomogrsphy and magnetic resonance tomography. Materials and Methods. A retrospective study was conducted based on the findings of multispiral computed and/or magnetic resonance tomographies of 68 patients. Presence of a fungal process was confirmed by histopathologic, mucroscopic, and cultural investigations. Results and Discussion. Histological investigations of surgical specimen detected the presence of fungal bodies formed by mycelium, i.e., a cluster of densely, compactly located fungal flocci in 28 of 48 (58.3 %): In 28 patients with maxilla sinus lesions, in 14 patients with sohenoidal sinus lesions, and in 5 patients with ethmoidal sinus lesions. In case of acute invasive fungal rhinosinusitis, the computed tomography of paranasal sinuses detected mucosal thickening and the bone density decrease associated with an erosive process. Unilateral lesions, erosions, and thinning of the sinus bone walls. According to magnetic resonance tomography, there was low signal in T2 mode, which is determined by the high concentrations of various metal elements in fungi, as well as by a high protein level and low free water contents in mucine. Conclusions. Visualization is essential to staging the disease and assessing the involvement of deeper structures, which may be clinically unmanifest. Although both computed tomography and magnetic resonance tomography are useful, the contrast-enhanced magnetic resonance tomography is the method of choice and helps assess the spread of the disease, especially regarding the deep extension into maxilla-facial area and brain.

A retrospective study of invasive fungal rhinosinusitis in adults for surgical outcomes at tertiary care hospital

Background: An invasive fungal rhinosinusitis is most lethal form of sinusitis. It includes acute and chronic invasive fungal rhinosinusitis. The most lethal fungi are Aspergillous species and mucormycosis, others are Alternaria, P. boydii and Sprothrix. Endoscopic debridement combined with intravenous antifungals are efficacious in management of invasive fungal rhinosinusitis. Methods: Study conducted at department of otorhinolaryngology, GMERS Medical College and Hospital, Sola, Ahmedabad. The period of the study October 2020 to October 2022. Total 100 cases taken. All cases of biopsy proven invasive fungal rhinosinusitis above the age of 18 years are included in this study. Oral and written consent taken from all included patients. A nasal endoscopy followed by KOH mount, magnetic resonance imaging – peripheral nervous system (MRI PNS) done. Results: In our study, 57% patients were surgically treated with functional endoscopic sinus surgery, 23% patients treated with modified Denker’s approach debridement. On basis of MRI PNS, nasal endoscopy and symptomatic improvement of the disease, only 10 patients have recurrence of disease and 90 patients are completely recovered after surgical and medical management. Conclusions: Maintaining high index of suspicion in at risk patient populations, followed by prompt evaluation and management is crucial in suspected invasive fungal rhinosinusitis. Early management with antifungal e.g. Amphotericin B intravenous injections, tab Posaconazole, tab Voriconazole and surgical intervention e.g. FESS, modified Denker’s approach debridement, FESS with middle meatal antrostomy very efficacious in terms of preventing the recurrence and mortality in patients.

Acute invasive fungal rhinosinusitis in post-COVID-19 patients in Vietnam

Acute invasive fungal rhinosinusitis (AIFR) is a potentially lethal infection commonly found in immunocompromised patients. It is considered the most aggressive subtype of fungal sinusitis and can lead to severe morbidity and mortality. There was a significant increase in the incidence of AIFR in post-COVID-19 patients compared to AIFR cases before the COVID-19 pandemic. This study aimed to describe the clinical presentation of AIFR associated with COVID-19 illness. A retrospective study included 22 patients diagnosed with AIFR with a recent COVID-19 infection. The most frequent disease associated with AIFR was diabetes mellitus (95.5%). The mycological analysis identified infection caused by Aspergillus species in 72.7% of patients. Along with stabilizing hemodynamic parameters and controlling any comorbidities, all patients in the present study underwent combined surgical debridement followed by antifungal medications. The overall survival rate was 72.7%. The chance of developing a fatal outcome was significantly higher if meningitis presented initially (odds ratio 35.63, p<0.05). The presence of meningitis upon initial diagnosis is related to a significantly higher chance of developing a fatal outcome and should be considered, especially in AIFR patients previously treated for COVID-19 infections. Early diagnosis, early use of antifungal agents, aggressive surgical debridement, and control of comorbid conditions remain crucial in managing AIFR.

Acute invasive fungal rhinosinusitis (AIFRS) - A histopathological analysis of expanding spectrum of fungal infections in backdrop of COVID-19 pandemic.

Acute invasive fungal rhinosinusitis (AIFRS) is an aggressive infection affecting immunocompromised patients and carries a high morbidity and mortality. It is commonly seen in immunocompromised patients, mainly in uncontrolled diabetes, malignancy, acquired immunodeficiency syndrome, and so on. However, there has been an exponential increase in the incidence of AIFRS in relation to recent coronavirus disease 2019 (COVID-19) infection. We present this study to assess histomorphological features of fungal infections in the background of COVID-19 era. The study includes interpretation of 34 biopsies of suspected AIFRS in post COVID-19 patients. The demographic details like patients age, sex, diabetic status, COVID-19 status, and history of steroid intake were collected. All specimens were stained with hematoxylin and eosin and PAS stain. Detailed microscopic examination including the presence of fungal hyphae in the tissue, characterization of inflammatory response, presence of tissue invasion, angioinvasion, and necrosis was noted for each case. Thirty-four biopsy specimens from various sites - nasal cavity, maxillary sinus, ethmoid sinus, and so on - were studied. The mean age of the patients with AIFRS was 52.68 years. The dominant fungi were Mucorales in 31 (91.3%), Aspergillus and Mucorales in 1 (2.9%), a combination of Mucorales and Candida identified in 1 (2.9%) case, and Candida alone in 1 case (2.9%). Bony invasion and perineural invasion were observed in 5 cases (14.7%) and 1 (2.9%) case, respectively. Histopathological examination plays an essential role in the diagnosis and appropriate management of the patients. Histopathological features including characterization of fungi, angioinvasion, and bone invasion may provide information on rare dreaded infections in post-COVID-19 patients for possible prognostic characteristics on histology.

Magnetic resonance imaging in COVID-19-associated acute invasive fungal rhinosinusitis - Diagnosis and beyond.

The aim of the study was to evaluate the magnetic resonance imaging (MRI) features of acute invasive fungal rhinosinusitis (AIFRS) at presentation and on follow-up imaging when patients receive treatment with systemic antifungal therapy and surgical debridement. This is a retrospective analysis of imaging data from a cohort of patients diagnosed with AIFRS during the second wave of COVID-19 in single tertiary referral hospital in South India between March 2021 and May 2021 (n = 68). Final diagnosis was made using a composite reference standard which included a combination of MRI findings, clinical presentation, nasal endoscopy and intraoperative findings, and laboratory proof of invasive fungal infection. Analysis included 62 patients with "Definite AIFRS" findings on MRI and another six patients with "Possible AIFRS" findings on MRI and laboratory proof of invasive fungal infection. Follow-up imaging was available in 41 patients. The most frequent MRI finding was T2 hypointensity in the sinonasal mucosa (94%) followed by mucosal necrosis/loss of contrast-enhancement (92.6%). Extrasinosal inflammation with or without necrosis in the pre-antral fat, retroantral fat, pterygopalatine fossa, and masticator space was seen in 91.1% of the cases. Extrasinosal spread was identified on MRI even when the computed tomography (CT) showed intact bone with normal extrasinosal density. Orbital involvement (72%) was in the form of contiguous spread from either the ethmoid or maxillary sinuses; the most frequent presentation being orbital cellulitis and necrosis, with some cases showing extension to the orbital apex (41%) and inflammation of the optic nerve (32%). A total of 22 patients showed involvement of the cavernous sinuses out of which 10 had sinus thrombosis and five patients had cavernous internal carotid artery involvement. Intracranial extension was seen both in the form of contiguous spread to the pachymeninges over the frontal and temporal lobes (25%) and intra-axial involvement in the form of cerebritis, abscesses, and infarcts (8.8%). Areas of blooming on SWI were noted within the areas of cerebritis and infarcts. Perineural spread of inflammation was seen along the mandibular nerves across foramen ovale in five patients and from the cisternal segment of trigeminal nerve to the root exit zone in pons in three patients. During follow-up, patients with disease progression showed involvement of the bones of skull base, osteomyelitis of the palate, alveolar process of maxilla, and zygoma. Persistent hyperenhancement in the post-operative bed after surgical debridement and resection was noted even in patients with stable disease. Contrast-enhanced MRI must be performed in all patients with suspected AIFRS as non-contrast MRI fails to demonstrate tissue necrosis and CT fails to demonstrate extrasinosal disease across intact bony walls. Orbital apex, pterygopalatine fossa, and the cavernous sinuses form important pathways for disease spread to the skull base and intracranial compartment. While cerebritis, intracranial abscesses, and infarcts can be seen early in the disease due to the angioinvasive nature, perineural spread and skull base infiltration are seen 3-4 weeks after disease onset. Exaggerated soft-tissue enhancement in the post-operative bed after debridement can be a normal finding and must not be interpreted as disease progression.

Magnetic resonance imaging manifestations of vascular complications in patients with acute invasive fungal rhinosinusitis

BackgroundOwing to significant morbidity and mortality with the development of vascular complications in patients with acute invasive fungal rhinosinusitis (AIFRS), early identification, and rapid medical or surgical interventions that are essential for improving patients’ outcomes. For the purpose of presurgical mapping and management planning, magnetic resonance imaging (MRI) is essential for the early identification and improved delineation of disease extent.ObjectiveTo evaluate variable MRI manifestations in the detection of the vascular complications in patients with AIFRS and its impact on patients’ survival.MethodsA retrospective study, included 24 patients with histopathological proven AIFRS to review the para nasal sinus MRI findings. MRI were evaluated for the sinus involvement and the extrasinus extension into the orbit and/or the brain. Vascular structures were assessed for the development of vascular complications, like ICA for thrombosis, attenuation or pseudoaneurysm, cavernous sinus and superior ophthalmic veins for thrombosis.ResultsOf the reviewed 24 patients, 16 had cavernous sinus thrombosis, 15 had ICA thrombosis, 10 had ophthalmic vein thrombosis, 4 had ICA attenuation and only two cases had pseudoaneurysm of the ICA. Vascular thrombosis was more common with mucormycosis with cavernous sinus and ophthalmic vein thrombosis which were significantly increased among non survivor patients (90%, 70%), as compared to the survivor patients (50%, 14.29%), with P = 0.04 and 0.005 respectively.ConclusionsVascular complications are common in patients with AIFRS. MRI is helpful in accurate detection of vascular complications in patients with AIFRS.

Rehabilitation of a Post-Covid Rhinosinusitis Patient with Exenterated Orbital Defect Using a Self-Retained Silicone Prosthesis - A Case Report

A 56-year-old female patient reported to the Department of Prosthodontics for the replacement of right eye. The patient gave a history of covid 1.5 years back and was diagnosed with diabetes for which she was prescribed oral antidiabetic drugs. The patient was apparently alright for 1-year post-covid treatment, after which she noted swelling around the right eye with gradual loss of vision and loss of movement of the right eyeball. It was diagnosed as post-covid acute invasive fungal rhinosinusitis. The patient underwent exenteration for the same.&#x0D; On examination, an orbital defect was noted, measuring 3.7cm mediolaterally, 3.5 cm superoinferiorly and with depth of 3.6 cm (measured at deepest point). The floor of the defect was completely healed with no signs of inflammation/ bleeding/ pus discharge, and with mild scarring at the base [Figure 1]. Patient’s written consent was obtained for the use of original photographs for publication.

Invasive fungal rhinosinusitis associated with COVID-19: Course changes and prognosis predictors

BackgroundThis study aimed to analyze the behavior of acute invasive fungal rhinosinusitis (AIFRS) associated with COVID-19 infection as there has been an increase in the rate of AIFRS cases in the last two years, and many reports connected this rising with the COVID-19 infection. We studied most factors that may impact the prognosis as a trial to find the most affecting factors to improve the outcomes. MethodsIt was a retrospective observational study that included cases from four tertiary referral institutions between November 2020 to February 2022. We included sixty-six patients who suffered from AIFRS associated with confirmed COVID-19. We observed the prognosis of all included patients with a six-month follow-up. We correlated the prognosis with many factors, such as demographic data, medical conditions, blood investigations, the features of fungal infections, and management. ResultsForty-two patients (64%) survived after the AIFRS associated with COVID-19, and twenty-two patients (36%) died. High doses of corticosteroids with prolonged use were the main factors that affected the behavior of the AIFRS associated with COVID-19. HbA1c was a good predictor of the prognosis; a level less than 9.35% may indicate survival with 87.5% sensitivity. ConclusionsAccording to this multi-center study, the mortality of the AIFRS associated with COVID-19 was high. The behavior was affected by glycemic control, the type of fungal species, and the type of antifungal therapy. Early surgical debridement, a combination of Amphotericin B with Voriconazole, and anticoagulants helped improve the prognosis.

Increased acute invasive fungal rhinosinusitis in COVID-19 patients

Aim: Acute invasive fungal rhinosinusitis (AIFRS) is a rare infection of the nose and paranasal sinuses that can be fatal. Infection may lead to tissue infarction, necrosis, and thrombosis and rapidly spread intracranially. The aim of this study is to highlight the increasing cases of AIFRS after covid-19 and to investigate the parameters affecting mortality.&#x0D; Material and Method: Total 11 patients diagnosed with AIFRS after COVID-19 were included in this study. Patient age, gender, comorbid diseases, initial symptoms, time between COVID-19 diagnosis and AIFRS diagnosis, intensive care hospitalization history, medical treatments, surgical findings, antifungal treatment, fungal species grown in culture, mortality, and the relationships of these parameters with mortality were also evaluated.&#x0D; Results: A total of 11 patients diagnosed with AIFRS after COVID-19 were included in the study. Among these patients, 81.8% were male, 18. 2% were female, and ages ranged from 57 years to 89 years. The mean time between COVID-19 infection and development of IFRS in patients was 26.09±18.04 days. The initial symptoms in 45.45% of the patients were unilateral periorbital edema, vision loss, and total ophthalmoplegia. The surgical approach was purely endoscopic in all patients. In our study, the mortality rate was 72.7% in COVID-19 related AIFRS patients.&#x0D; Conclusion: As a result, in our study, we found an increase in AIFRS incidence and mortality due to the systemic effects of COVID 19 and the treatments used for it. AIFRS should be suspected when a patient presents acute sinusitis symptoms after COVID-19 infection.

Neurosarcoidosis – A diagnostic challenge?

Background: Sarcoidosis is an inflammatory granulomatous multisystem disease with an unknown etiology. Neurosarcoidosis is a cryptogenic neuroinflammatory manifestation of sarcoidosis. Objective: This article aims at better understanding of one of the rarer diseases whose diagnosis may be difficult leading to delay in definitive management of the patient. Method: We describe a case of neurosarcoidosis with initial presentation similar to acute invasive fungal rhinosinusitis, whose diagnosis was challenging and delayed owing to the presenting symptoms. Conclusion: The diagnosis of neurosarcoidosis becomes challenging when it presents as isolated clinical neurological symptoms. We want to highlight the variable nature of neurosarcoidosis and its consideration as diagnosis after excluding other common infectious and inflammatory conditions.

Imaging Features of COVID-19-Associated Acute Invasive Fungal Rhinosinusitis

Abstract Background Acute invasive fungal rhinosinusitis (AIFR) is a rare, rapidly progressive, and life-threatening infection involving the nasal cavity and paranasal sinuses. Purpose of this study is to describe imaging features of coronavirus disease-2019 (COVID-19)-associated AIFR. Methods This was a retrospective observational study. Inclusion criteria: (1) post-COVID-19 patients with fungal rhinosinusitis detected on potassium hydroxide smear or histopathology; (2) onset of symptoms (facial pain, dental pain, facial swelling or discoloration, nasal bleed, periorbital swelling, ptosis, redness of eyes, vision loss) less than 4 weeks; and (3) magnetic resonance imaging/computed tomography (MRI/CT) done within 5 days before surgery. Exclusion criteria: (1) cases of sinusitis without a history of previous COVID-19 infection; and (2) cases in whom fungal hyphae were not demonstrated on pathological examination. Noncontrast CT and dedicated MRI sequences were done initially. Site of involvement, unilateral/bilateral involvement, pattern of mucosal thickening, enhancement pattern, periantral invasion, orbital invasion, intracranial involvement, perineural spread, vascular involvement, and bony involvement were recorded. CT and MRI imaging features were compared. Results Analysis of 90 studies (CT and MRI) in 60 patients was done. Most common site of involvement was ethmoid followed by maxillary sinus. Bilateral disease was more common. Mucosal thickening with T2 hypointense septations was seen in 88.4% MRI studies. Periantral and orbital involvement was seen, respectively, in 84.6% and 55.7% cases of MRI. Intracranial involvement was noted in form of meningitis, cerebritis, abscess, infarct, hemorrhage, cavernous sinus, or perineural invasion. Vascular involvement was noted in form of vascular occlusion (n = 3), vascular narrowing (n = 3), and pseudoaneurysm (n = 2). MRI was more sensitive in detecting periantral invasion, deep infratemporal fossa, cavernous sinus involvement, perineural invasion, optic nerve involvement, and vascular occlusion and narrowing, while CT was superior in identification of bony erosions. Conclusion Early recognition of AIFR in post-COVID-19 patients is important to prevent disease-related morbidity/mortality. Several rarely described findings are noted in our series of AIFR, like optic nerve involvement, pituitary fungal abscess, perineural spread, fungal aneurysms, and arteritis-related posterior circulation infarcts. MRI is superior for early detection of disease and in estimation of extent of disease, compared with CT. Imaging can help in early detection of AIFR, which has a significant impact on patient outcome.

Is low dose of liposomal amphotericin B effective in management of acute invasive fungal rhinosinusitis? Our conclusions from Al-Mowassat University Hospital, Syria: a prospective observational study

BackgroundAcute invasive fungal rhinosinusitis (AIFRS) is a fatal infection associated with high morbidity and mortality. Although it is a rare disease, upsurge of AIFRS was noticed during the second wave of COVID-19 disease. Early diagnosis and management is the cornerstone for good outcomes. However, management of AIFRS is challengeable especially in developing countries due to limited resources and high prices of antifungal agents. No previous studies have been conducted to evaluate the outcomes of management of AIFRS in Syria. The purpose of this study is to report the results of management of AIFRS with low doses of liposomal amphotericin B in our tertiary hospital in Syria.MethodsThe outcomes of management of AIFRS cases were followed through a prospective observational study between January 2021 and July 2022. The required medical data were collected for each individual. Three-month mortality rate was studied. SPSS v.26 was used to perform the statistical analysis. Pearson Chi-square test was used to study the associations between different variables and mortality. Survival curves were plotted by the Kaplan–Meier to compare the survival probability. Log Rank (Mantel-Cox) test and Cox regression were conducted to evaluate the factors affecting survival within the follow up period.ResultsOf 70 cases, 36 (51.4%) were males and 34 (48.6%) were females. The mean age of patients was 52.5 years old. The most common underlying risk factor was diabetes mellitus (84.3%). The used dose of liposomal amphotericin B ranged between 2–3 mg/kg per day. The overall 3-month mortality rate was 35.7%. Significant association was found between survival and the following variables: Age, orbital involvement, stage, and comorbidity.ConclusionThe overall mortality rate was close to other studies. However, survival rate was worse than comparable studies in selected cases of AIFRS (older ages, involved orbits, advanced stages, and chronic immunodeficiency). Therefore, low doses of liposomal amphotericin B could be less effective in such cases and high doses are recommended.

Study of Clinicoepidemiology and Surgical Complications in Acute Invasive Fungal Rhinosinusitis.

To study clinicoepidemiology and surgical complications in acute invasive fungal rhinosinusitis. Retrospective observational study carried in GMC Akola from February 2021 to April 2022. Detailed history and clinical examination, nasal endoscopic biopsy or swab for KOH and fungal culture was taken. CECT/MRI PNS + Orbit + Brain was done. All patients underwent surgery and tissue sample send for histopathological examination. Total 146 patients included in study with M:F ratio 1.7:1. Most affected age group was between 40 and 60years. 107 (78.6%) patients had history of COVID-19.Mucorale is most commonly found fungal species (90.4%) followed by aspergillus (2.7%) & mixed species (6.8%). Diabetes Mellitus is most common comorbidity. Intraoperative complications were bleeding (72.60%), CSF leak (4.1%), orbital hematoma (0.68%), nasolacrimal duct trauma (2.05%), periorbital hematoma (0.68%). Post operative complications like synechiae (56.16%), OAF (45.89%), hypoesthesia (25.34%), decreased vision (16.43%), facial pain (20.54%), facial deformity (20.54%), diplopia (6.8%), headache (30.13%), anosmia (39.72%), dental pain (20.54%), earache (9.58%), hyposmia (45.89%), periorbita ecchymosis (0.68%), residual disease (16.10%), recurrence (2.05%), death (2.05%) was observed. Prompt surgical debridement of devitalized tissue and early adequate dosage of antifungal (inj. Amphotericin-b) treatment are necessary as delay in surgical debridement and treatment can worsen the prognosis of disease. Among all complications faced maximum were manageable with early interventions but few of them were inevitable due to extensive nature of disease.

Epidemiological Characteristics, Pathogenesis and Clinical Implications of Sinusitis in the Era of COVID-19: A Narrative Review.

Sinusitis is a common condition with various forms and different etiologies. In the era of COVID-19, a large number of studies covered the association between sinusitis and COVID-19, while others reported the impact of COVID-19 on the development of acute invasive fungal rhinosinusitis (AIFR), together with the most commonly associated predisposing factors. Fungal sinusitis, particularly AIFR, can be life-threatening. It is important to dissect this association and improve current evidence and management. Therefore, we conducted this literature review to highlight the association between COVID-19 and sinusitis based on evidence from the available studies in the literature. Evidence shows that chronic sinusitis might have a negative impact on COVID-19 outcomes. However, current results are conflicting, and further studies are needed. On the other hand, COVID-19 can also cause olfactory dysfunction, which is usually temporary. In addition, we found several studies that indicated the association between COVID-19 and AIFR. The condition is usually associated with severe morbidities, as affected patients are usually immunocompromised, including those with uncontrolled diabetes, malignancy, immunosuppression, AIDS, the administration of chemotherapy and other immunosuppressive drugs, and COVID-19.

Magnetic resonance and computed tomographic findings in acute invasive fungal rhino sinusitis during COVID-19 pandemic

Magnetic resonance and computed tomographic findings in acute invasive fungal rhino sinusitis during COVID-19 pandemic