Acute Invasive Fungal Rhinosinusitis Research Articles

Post COVID MucormycosisA Narrative Review

Mucormycosis is an Acute Invasive Fungal Rhinosinusitis (AIFR). Omnipresent fungi and their interaction with humans are both boon and a bane. Fungal rhinosinusitis is now becoming an alarming situation in today’s world, especially in India. It can be classified further into invasive or non invasive and acute or chronic. Categorisation helps us with its diagnosis and management. The invasion of the hyphae portrays mucormycosis into sinus tissue within less than four weeks. It comes with various predisposing factors such as underlying systemic disease, drug therapy, transplantation, and local lesion. Clinical manifestations such as headache, sinonasal congestion, black lesions on the nasal bridge, and facial inflammation associated with pain are prevalent in immunocompromised patients. Crucial steps such as early identification, definite treatment with a multidisciplinary integrated approach of various departments such as ENT, medicine, and radiology should be made. Intraorbital and intracranial complications can be prevented by treating disease process in the early stage.

Unusual infections and diabetes: dangerous fungi

Unusual infections and diabetes: dangerous fungi

Rapid Diagnosis and Epidemiology of Fungal Rhinosinusitis in PostCOVID-19 Patients.

Fungal rhinosinusitis (FRS) cases are not exiguous for the world. However, their spike as a postCOVID sequelae has alarmed the world, especially India. Adding to the woes is the high mortality rate and poor prognosis associated with acute invasive fungal rhinosinusitis (AIFR) in such immunocompromised patients. In such a scenario, early and precise diagnosis of AIFR is what a patient and physician banks upon. KOH and histopathology are the two frontline investigations for the diagnosis of FRS. Our study aimed at analyzing the cases of FRS by histopathology and comparing these with KOH. Prospective longitudinal study including suspected postCOVID FRS patients over a period of 1.5 months. Their clinical, histopathological, and KOH findings were then correlated. About 72.5% clinically suspected fungal infection specimens were found to be positive for fungal elements on histopathology. Of these, only 30 cases were positive by KOH mount. Maximum patients belonged to 40-70 years of age; males (67%) more than females. Sites involved were paranasal sinuses (100%), nasal (88%), and orbital (25%). Histopathology revealed mucormycosis (100%) and aspergillosis (16%). Angioinvasion was identified in 38% of the mucormycosis cases. In a state of crisis, when the gold standard for fungal identification i.e., culture can take as many as 21 days for final report and early and judicious antifungal treatment is sine qua non of recovery, histopathology has proved to be better than KOH as far as early and precise diagnosis of fungal elements and their invasion is concerned.

Clinical features, diagnosis, and treatment outcome of Rhino-orbito-cerebral mucormycosis: A 2-year experience at a tertiary care center

ABSTRACT Context: The incidence of the fungal disease, mucormycosis, is showing a steady increase among the Indian population in recent past years. Considered as a form of acute invasive fungal rhinosinusitis, the disease is characterized by high morbidity and mortality rates. Aims: The aim of this study was to study the clinical presentations, species distribution, and treatment outcomes in patients of rhinomucormycosis. Settings and Design: This was a tertiary care hospital-based case series. Subjects and Methods: The study was carried out between June 2018 and February 2020. All laboratory-confirmed cases of rhinomucormycosis were included in the study population. Results: Sixteen cases of histopathologically and microbiologically confirmed cases of rhinomucormycosis were included in the study. The study population included ten females and six males. Diabetes mellitus was found to be the most common comorbid condition in the study group (81.25%). Among the study group, swelling of cheek and thick blood-stained discharge were the most common presenting symptoms (9 cases out of 16). The most common clinical type was rhino-orbital mucormycosis. Rhizopus was the most common species encountered (87.5%). In spite of utmost care, treatment outcome was not favorable in most of the cases. Conclusion: An early diagnosis of mucormycosis in the background of immunocompromised status can help in initiating appropriate treatment, thereby reducing the morbidity and mortality associated with this disease condition.

Unmasking the Uncommon: Post COVID-19's Sinister Encore - A Clinical Report of Acute Invasive Fungal Rhinosinusitis in a Non-Diabetic, Non-Steroid Therapy Patient.

Unmasking the Uncommon: Post COVID-19's Sinister Encore - A Clinical Report of Acute Invasive Fungal Rhinosinusitis in a Non-Diabetic, Non-Steroid Therapy Patient.

Egyptian clinical pathway for post COVID-19 acute invasive fungal rhinosinusitis

Egyptian clinical pathway for post COVID-19 acute invasive fungal rhinosinusitis

Post COVID-19 Mucormycosis-The Horizon.

Acute Invasive Fungal Rhinosinusitis is a rare condition which recently has gained attention due to its increased occurrence in the post COVID-19 patients past the second wave. The current study retrospectively evaluates the occurrence of Acute Invasive Fungal Rhinosinusitis (Mucormycosis) in post COVID-19 (Corona Virus Disease-19) patients. A descriptive study included patients diagnosed with Acute Invasive Fungal Rhinosinusitis (Mucormycosis) after recent COVID-19 infection. 110 patients were evaluated retrospectively with histopathological confirmation of Mucormycosis. Surgical treatment was restricted to patients who tested Real Time Polymerase Chain Reaction (RT PCR) negative for COVID-19 except for three patients who were tested positive. Antifungal agents were given to patients following surgery. A total of 110 patients with a mean age of 48.42 years were included. The most common risk factor was diabetes mellitus (88.2%). Sino-nasal, orbital, palatal and intracranial involvement were 57.9%, 48.5%, 12.7% and 5.6% respectively. Histopathological confirmation revealed mucormycosis. The most common reported symptoms were periorbital oedema (20.5%), headache (20.3%), gingival swelling (18.5%) facial pain (18.4%) and facial swelling (18.2%). All the patients were treated with surgical debridement and antifungal medications. The overall survival rate was 95.32%. Acute Invasive Fungal Rhinosinusitis is a life-threatening opportunistic infection. Patients with moderate to severe COVID-19 infection are more susceptible to it. Uncontrolled diabetes mellitus and intake of corticosteroids increase the risk of developing Acute Invasive Fungal Rhinosinusitis. Early diagnosis and timely management can improve survival rates of the patients.

COVID-Associated Sinonasal Mucormycosis: Radiological Pathological Correlation and Prognostic Value of MR Imaging.

Purpose Our aim was to assess the sinonasal magnetic resonance imaging (MRI) features of acute invasive fungal rhinosinusitis (AIFRS) in coronavirus disease (COVID)-associated mucormycosis (CAM) and to correlate these with histopathology and patient outcome in terms of duration of hospital stay and survival at 10 weeks. Methods Twenty patients with histopathologically confirmed sinonasal CAM underwent MRI (including postcontrast T1-weighted and diffusion-weighted imaging). Histopathological findings (presence of coagulative necrosis, granulomatous reaction, and fungal burden) were recorded and all patients were followed up at 6 and 10 weeks. Statistical analysis was done using chi-square test and Fischer's exact test. Results Enhancement patterns seen in our subjects included homogeneous, heterogeneous, and lack of contrast enhancement (LOC), with LOC being the most common (65%). Diffusion restriction was found in 90% patients. Statistically significant correlation was found between LOC pattern and presence of coagulative necrosis ( p -value = 0.007), extent of fungal hyphae ( p -value = 0.047), and duration of hospital stay ( p -value = 0.004). Restricted diffusion was also seen to correlate with a high fungal load ( p -value = 0.007). Conclusion Our study describes the MRI findings of AIFRS in CAM and highlights the imaging features which may be surrogate markers for coagulative necrosis and fungal burden.

Post-COVID-19 Invasive Fungal Sinusitis: A Case Series from Southern India

Acute Invasive Fungal Rhinosinusitis (AIFR) is a serious condition with aggressive course and high mortality rates. There is an upsurge in the incidence of invasive fungal rhinosinusitis in post COVID-19 patients. We have come across 20 AIFR cases in post COVID-19 patients. On retrospective exploration of the patient’s records, we found that 30% patients had received steroids and 90% had diabetes. All the patients were managed by administration of IV amphotericin B and local debridement of infected tissues. The mortality rate was as low as 15 %. We conclude that combined approach of Antifungal therapy with debridement of infected tissues improves the prognosis and survival of AIFR patients.

Orbital Complications of Acute Invasive Fungal Rhinosinusitis: A New Challenge in the COVID-19 Convalescent Patients.

Increased incidence of acute invasive fungal rhinosinusitis (AIFR) in the setting of COVID-19 is undeniable. This can be attributed to its effect on innate immunity and extensive use of corticosteroids. The goal of our study was to assess the orbital complications of AIFR and its management in the COVID-19 convalescent patients. Our longitudinal prospective study included 45 patients with orbital complications of AIFR in recently recovered COVID-19 patients. We performed otorhinolaryngological, ophthalmological, and neurological examinations to monitor the manifestations of the disease. Computed tomography and contrast enhanced magnetic resonance imaging were performed to detect the extent of infection. Antifungal medications, surgical intervention, and general condition management were all provided to all the patients. We reported pre-septal cellulitis, orbital cellulitis, and orbital apex syndrome in 18, 13, and 10 patients, respectively. Four patients had cavernous sinus thrombosis. Mucormycosis and Aspergillus species were detected in 80% and 11.11% of our patients, respectively, while the mixed infection was found in 8.88% of our patients. Diabetes mellitus was the most common cause of immunocompromise (95.55% of our patients). Orbital pain and ophthalmoplegia were the most common ocular manifestations, followed by proptosis and relative afferent pupillary defect. All patients underwent surgical intervention, except for one patient who was unfit for surgery. One patient had orbital exenteration. The ophthalmological manifestations were reversible in cases of orbital and pre-septal cellulitis. The overall survival rate was 66.67%. Early diagnosis and treatment of AIFR can decrease the morbidity and mortality rate of affected patients.

Post Covid-19 Acute Invasive Fungal Rhinosinusitis (AIFR): A Study of Histopathological Findings After FESS in Radiologically Diagnosed AIFR.

COVID-19 pandemic has led to a concerning surge of post-COVID-19 AIFR. Mucormycosis (BLACK fungus) is a rare but severe and life-threatening fungal infection occurred by mucormycetes, a family of moulds. More than 49,000 cases of AIFR were reported in three months in India. It primarily affects diabetics and spreads from the nasal cavity and paranasal sinuses (PNS). It also involves eye, palate, or brain. It is diagnosed clinically followed by radiological and pathological findings. We aimed to compare and analyse the pre-operative imaging with postoperative histopathological findings. The study was conducted in ENT department of tertiary care hospital, Rajkot. 200 patients were randomly selected who were presented to ENT OPD with clinically suspected Post COVID-19 AIFR. All patients underwent detailed ENT examination and radiological modality like MRI PNS, Brain, and Orbit. After proper pre-op evaluation, all patients underwent Functional Endoscopic Sinus Surgery (FESS). MRI findings were confirmed with that of histopathological findings done on KOH mount. All the patients were showing AIFR on MRI findings whereas 49% of patients had mucormycosis on Histopathology. Various other fungal infections like aspergillosis (7%), candidiasis (1.5%) were also found on HPE. 9% of patients showed combined infection with mucor and aspergillus species. Rest of the patients showed non-fungal rhinosinusitis. Inflow of the epidemic, plenty of patients were shown invasive fungal sinusitis in MRI patterns whereas many of them were HPE negative. Thus this study was done to know the efficacy of radiological features with pathological diagnosis. We have considered both procedures standard in our study.

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.

Clinical and mycological investigations of post-COVID-19 acute invasive fungal sinusitis.

An increased incidence of acute invasive fungal sinusitis associated with the recent COVID-19 pandemic has been observed, which is considered a public health concern. This study aims to detect the incidence, risk factors, causative agents, clinical presentations, outcomes, and susceptibility rate of various antifungals. In this cross-sectional cohort study, a total of 30 patients showing acute invasive fungal rhinosinusitis following a COVID-19 infection were investigated. Histopathological biopsies, culture identification, and molecular confirmation of the causative agents were conducted. The demographic data, risk factors, clinical presentations, treatment regimen and its outcomes, and efficacy of antifungals were listed and analyzed. A total of 30 cases with a mean age of 59.6 ± 11.9 years were included. Diabetes mellitus was the most recorded comorbidity with a rate of 86.7%, whereas most of the patients received corticosteroids. The mycological examination confirmed the existence of Mucor (Rhizopus oryzae) and Aspergillus (Aspergillus niger) in 96.7% and 3.3% of the cases, respectively. Various stages of sinonasal involvement (ethmoid, maxillary, sphenoid, and inferior turbinate) represented 100%, 83.3%, 66.7%, and 86.7% of the cases, respectively. Headache and facial pain, ophthalmoplegia, visual loss, and blindness represented 100%, 66.7%, 90%, and 53.3% of the cases, respectively. All the cases were simultaneously treated with surgical debridement and amphotericin B. Moreover, R. oryzae was susceptible to it, whereas A. niger was sensitive to voriconazole, resulting in a survival rate of 86.7% (26/30). The R. oryzae and A. niger isolates were proven to be sensitive to acetic acid, ethyl alcohol, formalin, and isopropyl alcohol. In patients with COVID-19, the diagnosis of acute invasive fungal sinusitis and prompt treatment with antifungal medicine and surgical debridement are important in achieving better outcomes and survival rates. 4.

COVID-19-related acute invasive fungal rhinosinusitis: risk factors associated with mortality

BackgroundAcute invasive fungal rhinosinusitis (AIFRS) is a rare aggressive life-threatening infection that affects immunocompromised individuals. Recently, an increase in the incidence of this infection has been reported in patients who have SARS-CoV-2 infection or recently recovered. This study was to assess the outcome and define risk factors that might affect the outcome in SARS-CoV-2-related AIFRS. A prospective observational study included 54 patients diagnosed with SARS-CoV-2-related AIFRS. Controlling the predisposing factors, systemic antifungal, and early surgical debridement was performed. The mortality rate was calculated. Age, sex, underlying risk factors, the extent of the disease, debridement technique, and other biochemical variables were evaluated regarding their impact on survival. Patients were followed up for 3 months.ResultsFifty-four patients with a mean age of 48.1 years. Diabetes mellitus was the most common comorbidity affecting 52 patients (96.3%). Intracranial and intraorbital extension had a predictive value for mortality (P value 0.050 and 0.049 respectively). However, only intracranial extension was the independent predictor of mortality. Biochemical variables were higher than the normal range, but only serum ferritin level above 165 ng/ml was an independent predictor of mortality in patients with AIFR. The mortality rate was 38.9%.ConclusionThe extent of the disease has a major impact on survival, so early diagnosis of AIFRS within patients infected with SARS-CoV-2 or recently recovered is essential to reduce mortality.

Invasive mucormycosis of nasal cavity, paranasal sinuses, bones of the skull in post COVID-19 patients: prospective study

INTRODUCTION: Since 2020, the number of patients with complications after a new coronavirus infection (COVID-19) has increased, including mycoses. Mucormycosis ranks third in the frequency of detection among invasive mycoses in patients with reduced immunity. Acute and chronic invasive fungal rhinosinusitis is the most severe and dangerous variant of the disease.OBJECTIVE: To analyze the features of the osteodestructive process of invasive mucormycosis, its relationship with blood supply, the dynamics of the process under the influence of treatment.MATERIALS AND METHODS: The study evaluated changes in the bone structures of the skull, soft tissues of the facial region, brain, and thorax in a group of 10 patients (62.3±11.4 y.o.) examined in the clinic of maxillofacial surgery and the clinic otorhinolaryngology in the post- covid period. The results of cone-beam computed tomography (Sirona) of the maxillofacial region, Xray computed tomography Optima 540 CT (General Electric) of the maxillofacial region and thoracic cavity organs, magnetic resonance imaging (GE Signa HDxt) of the brain and maxillofacial region with intravenous administration of a paramagnetic contrast agent were analyzed.RESULTS: In all cases, osteolytic lesions as a classical manifestations of invasive mucormycosis, were revealed in: alveolar processes of the upper jaws and walls of the maxillary sinuses in 100% of cases; palatine processes — 90%; nasal septum, walls of the ethmoid sinuses and walls the orbits — 70%; walls of the sphenoid sinus — 50%; pterygoid processes and zygomatic bone — 40%; the body of the sphenoid bone, nasal bones, frontal bones — 30%; the alveolar part of the mandible and temporal bone — 10%. All patients underwent surgery with resection of the affected bones — 100%, while 7 out of 10 patients received antimycotic therapy. When assessing the revealed changes in dynamics in all patients in the long-term postoperative period, sclerosis of small foci of destruction, a decrease in the extent of bone defects, a decrease in the size of sequesters, hyperostosis of the walls of the paranasal sinuses, cells ethmoid sinuses of the after sequestrectomy were noted. There were no fatal cases among the 10 patients we observed at the time of publication.CONCLUSION: The combination of anatomical features and the state of blood supply contributes to the development of invasive mucormycosis of the bones of the facial skull and the RCT data help with determining treatment tactics, the volume of surgery, and assessing dynamics in the early and long-term postoperative period.

Fourteen cases of acute invasive fungal rhinosinusitis: is there a place for less aggressive surgical treatment?

Acute invasive fungal rhinosinusitis (AIFRS) is a rare, fulminant, angio-invasive infection with high mortality rate. Treatment of AIFRS includes aggressive surgical debridement combined with antifungal agents and treatment of the underlying disease. The aim of this study is to report our experience with this often fatal disease and estimate the long-term survival of AIFRS patients with more conservative surgery. A retrospective study was performed on immunocompromised adults with AIFRS from January 2011 to December 2020. The diagnosis was histologically confirmed by tissue fungus invasion. We analyze epidemiological and microbiological findings, the underlying disease and discuss our patients' treatment plan and long-term survival. Fourteen patients were included in the study. Mean age was 53.8 ± 18.9years. The underlying disease was hematologic malignancy in nine patients, diabetes mellitus in three, aplastic anemia in one, and renal/liver failure in one. Leukopenia was not significantly correlated with outcome or survival. Histological and culture findings revealed that Mucor/Rhizopus were the causative organisms in nine cases. All patients received systemic antifungal therapy. Surgery was performed in nine patients (endoscopic for all patients, combined in three with an external approach). Overall survival was 35.7% as five patients survived, two who underwent surgery, and three who were treated non-surgically. Nine patients died, two from AIFRS after central nervous system involvement and seven from their primary disease, free of fungi. Older individuals and patients with hematologic malignancies had a worse outcome. Early surgical debridement, antifungal agents, and treatment of the underlying disease remain the cornerstones of AIFRS management. Prognosis is overall defined by the underlying disease and in some selected cases, medical treatment alone could be a reasonable option.

Mycological Profile of Acute Invasive Fungal Rhinosinusitis during COVID-19 Pandemic at a Tertiary Care Hospital

Introduction: During the coronavirus disease-19 (COVID-19) pandemic, a surge in acute invasive fungal rhinosinusitis (AIFRS) cases with high mortality was reported in India. Objective: The objective was to study the spectrum of fungus associated with AIFRS during the pandemic of COVID-19. Materials and Methods: A total of 51 patients who were clinically diagnosed as cases of acute invasive rhinosinusitis in the department of ear, nose and throat (ENT) were included in the study. The clinical data along with demographic details were noted, and fungal identification was done using a conventional method. Results: Out of 51 patients, 66.6% were males and 33.4% females. Predominantly affected age group was 41–50 years. Out of 51 patients, 92.15% (47/51) had suffered from COVID-19 and 7.8% (4/51) did not have COVID-19 infection previously. Thirty-seven patients out of 51 (72.54%) were diabetics. Out of 51 samples collected from patients, 94.11% (48/51) were fungal culture-positive and only 5.8% (3/51) were culture-negative. A total of 52 fungi were isolated from the 48 culture-positive samples. Mucormycetes were predominantly isolated from the samples followed by Aspergillus species and Candida species. Among mucormycetes, Rhizopus species was the predominantly isolated. Conclusion: Patients with COVID-19, especially those at high risk, need to undergo an ENT examination once they recover because an early identification of AIFRS and a strong clinical suspicion of the disease are crucial for a successful course of treatment and to improve patient prognosis.

P256 A rare case of co-infection with Nigrospora oryzae with mucormycosis in an immunocompromised post-COVID patient

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PMObjectiveA rare case of co-infection of Nigrospora oryzae with mucormycosis in an immunocompromised post-COVID patient.MethodsA 41-year-old male diabetic patient, with sub-optimal glycemic control, contracted COVID-19 infection and was managed with high-dose steroids. A month after recovery from COVID-19 infection, he developed severe headache with sudden onset right-sided facial swelling. A contrast-enhanced magnetic resonance imaging was done which was suggestive of infective/inflammatory rhinosinusitis with intracranial extension with a possibility of fungal etiology. Functional endoscopic sinus surgery was performed and tissue was sent for microbiological processing. On KOH mount, broad pauciseptate fungal hyphae were seen. Fungal growth was obtained on SDA at 25°C and 37°C within 4 days of inoculation. It was confirmed as Rhizopus arrhizus both phenotypically as well as by MALDI-TOF. Patient was put on antifungal therapy in form of Inj liposomal Amphotericin B 500 mg/d. However, patient had persistent headache, vomiting, and low-grade fever post-procedure. A repeat CE-MRI was performed which was suggestive of necrotic brain tumor/abscess and was planned for frontal lobe abscess drainage. Pus was inoculated on routine mycological media. On KOH mount, broad pauciseptate hyphae along with narrow septate hyphae were seen. Fungal growth was obtained on SDA at 25°C within 5 days of inoculation, which on LPCB were identified as Nigrospora spp. The identity of the isolate was confirmed by Next generation sequencing as Nigrospora oryzae. Post-2 weeks of treatment and strict glycemic control, patient started improving. The headache and swelling subsided. He was further started on oral hypoglycemic agents and discharged and was asked to follow up after a month.ResultsCOVID-19 epidemic that emerged by the end of 2019 has been associated with a huge number of deaths globally. Acute invasive fungal rhino-sinusitis is a potentially fatal infection in immune-compromised patients post COVID-19. Various studies reveal that invasive fungal infections have been the leading cause of death in 25%-73.7% of patients. Among these invasive fungal infections, Mucor spp. were detected in 77.8% patient, Aspergillus fumigatus in 30.6% while 8.3% showed mixed infection with both the fungi. Along with the established pathogenicity of Mucorales in causing invasive fungal infection, other fungal co-infections are also being observed. These invasive fungal infections in an immune-compromised host carry a high mortality and morbidity rate (18%-80%). Therefore, early diagnosis, followed by aggressive medical care, surgical debridement, and control of underlying diseases is of utmost importance.ConclusionAcute invasive fungal rhinosinusitis saw a spurt in incidence during the widespread COVID-19 pandemic.Diagnosis of invasive fungal infection is based on the clinical setting and characteristic presentation, supported by radiological and microbiological evidence. Prompt diagnosis and treatment are the need of the hour.

P135 Immunological correlation with clinicomycological aspects of fungal rhinosinusitis during COVID-19 pandemic

Poster session 1, September 21, 2022, 12:30 PM - 1:30 PM Background and ObjectivesTo determine the relation between disease spectrum, etiology, and immunological markers of fungal rhinosinusitis.Material and MethodsDiagnostic nasal endoscopy was used for the collection of sinus and nasal tissue samples which were processed as per standard mycological procedure for microscopy, culture and histopathological examination (HPE). Enzyme-linked immunosorbent assay was used for total IgE, serum IL-6, IL-10, TNF-α levels detection.ResultsOut of 148 samples, 70% were diagnosed as FRS. COVID-19 infection 46.9% was the most common comorbid condition. Use of steroid therapy 46.9% was the most common predisposing factor. Nasal obstruction 62.2% was the most common clinical feature but headache (P-value .002) and eye discharge were statistically significant (P-value .005). KOH mount revealed findings in 84.69% patients in this study. Combination of KOH, HPE, and fungal culture revealed findings in 62.2% cases. Rhizopus arrhizus 27.6% was the most common isolate Aspergillus flavus and Rhizopus arrhizus were statistically significant (P-value .003, .026 respectively). IL-6 59.2% was the most common serological marker raised in this study. PNS imaging revealed that 100% of the patients had single or multiple sinus involvement and maxillary sinus (P-value .038) was significantly associated. Acute invasive fungal rhinosinusitis 75.5% was the most common type of FRS. Mortality was 17.34% in this study.ConclusionFRS is an important emerging public health problem and a cause of mortality and morbidity, particularly in immunocompromised patients. Furthermore, in the current scenario of COVID-19 pandemic, FRS has become more fatal and an entity of immediate and grave concern than ever before.

Magnetic Resonance Imaging Prognostic Findings for Visual and Mortality Outcomes in Acute Invasive Fungal Rhinosinusitis

To identify initial, preintervention magnetic resonance imaging (MRI) findings that are predictive of visual and mortality outcomes in acute invasive fungal rhinosinusitis (AIFRS). Retrospective cohort study. Patients with histopathologically or microbiologically confirmed AIFRS cared for at a single, tertiary academic institution between January 2000 and February2020. A retrospective review of MRI scans and clinical records of patients with confirmed diagnosis of AIFRS was performed. For each radiologic characteristic, a modified Poisson regression with robust standard errors was used to estimate the risk ratio for blindness. A multivariate Cox proportional hazards model was used to study AIFRS-specific risk factors associated with mortality. Identification of initial, preintervention MRI findings associated with visual and mortality outcomes. The study comprised 78 patients (93 orbits, 63 with unilateral disease and 15 with bilateral disease) with AIFRS. The leading causes of immunosuppression were hematologic malignancy (38%) and diabetes mellitus (36%). Mucormycota constituted 56% of infections, and Ascomycota constituted 37%. The overall death rate resulting from infection was 38%. Risk factors for poor visual acuity outcomes on initial MRI included involvement of the orbital apex (relative risk [RR], 2.0; 95% confidence interval [CI], 1.1-3.8; P= 0.026) and cerebral arteries (RR, 1.8; 95% CI, 1.3-2.5; P < 0.001). Increased mortality was associated with involvement of the facial soft tissues (hazard ratio [HR], 4.9; 95% CI, 1.3-18.2; P= 0.017), nasolacrimal drainage apparatus (HR, 5.0; 95% CI, 1.5-16.1; P= 0.008), and intracranial space (HR, 3.5; 95% CI, 1.4-8.6; P= 0.006). Orbital soft tissue involvement was associated with decreased mortality (HR, 0.3; 95% CI, 0.1-0.6; P= 0.001). Extrasinonasal involvement in AIFRS typically signals advanced infection with the facial soft tissues most commonly affected. The initial, preintervention MRI is prognostic for a poor visual acuity outcome when orbital apex or cerebral arterial involvement, or both, are present. Facial soft tissues, nasolacrimal drainage apparatus, intracranial involvement, or a combination thereof is associated with increased mortality risk, whereas orbital soft tissue involvement is correlated with a reduced risk of mortality.