Fungal Rhinosinusitis Research Articles

Number of sinus procedures reduces inpatient mortality for invasive fungal rhinosinusitis

ObjectivesTo evaluate surgical outcomes of invasive fungal rhinosinusitis Materials and methodsThe National Inpatient Sample Database (2000–2015 Q3) was queried for patients with a diagnosis of aspergillosis and/or mucormycosis and a diagnosis of acute sinusitis using the International Classification of Diseases, Ninth Edition. Factors associated with inpatient mortality were then identified with multivariate logistic regression. Results514 adult patients with a median age of 57.0 years were identified, of which 231 (44.9 %) underwent sinus surgery. Surgical patients had a longer length of stay (17.0 vs 9.0 days, p < 0.001) and higher total charges ($139,762.00 vs $57,945.00, p < 0.001). The number of sinus procedures was associated with reduced odds of inpatient mortality (OR 0.69; p < 0.001) in multivariate analysis. Hypertension (OR 0.34, p = 0.002) and chronic kidney disease (OR 0.23, p = 0.034) were associated with reduced odds of inpatient mortality. Total number of procedures (OR 1.24; p = 0.002), mucormycosis (OR 2.75, p = 0.002), age (OR 1.03, p = 0.006) and acid-base disorders (OR 2.85, p = 0.012) were associated with increased odds of inpatient mortality. ConclusionThis represents the first large scale study to evaluate outcomes for invasive fungal rhinosinusitis. These findings suggest the odds of inpatient mortality decrease with greater extent of sinus surgery performed. The potentially protective roles of hypertension and chronic kidney disease should be evaluated in future research.

Burden of Fungal Rhinosinusitis in Rhinology unit of Tribhuvan University Teaching Hospital, Kathmandu

Burden of Fungal Rhinosinusitis in Rhinology unit of Tribhuvan University Teaching Hospital, Kathmandu

Dupilumab as an emerging treatment for refractory allergic fungal rhinosinusitis: a case series and literature review

Background: Allergic Fungal Rhinosinusitis (AFRS) is a chronic, inflammatory, non-invasive fungal disease of the nose, sinuses, and paranasal sinuses. Dupilumab is an emerging biological therapy with promising outcomes in the treatment of patients with refractory AFRS. In this case series, we aimed to assess the effectiveness and safety of dupilumab in the treatment of refractory AFRS. Case description: Our case series included seven patients, all of whom met the inclusion criteria. Of these, four were male (57.1%) and three were female (42.9%). The ages of the patients ranged from 20 to 44 years, with a mean of 30.4. For post-treatment Sinonasal Outcome Test-22 (SNOT-22) scores, six patients (85.7%) reported improvement by one category (two from severe to moderate and four from moderate to mild). Only one patient (14.2%) reported an improvement by two categories (severe to mild). Post-treatment IgE levels ranged from 39 to 590 IU/mL, with a mean of 301.8 IU/mL. There was a significant decrease in the mean IgE level by 93% after dupilumab administration. The average number of surgeries in the included patients ranged from 2 to 4, with a mean of 2.7 surgeries. Post-treatment, none of the patients required revision surgery or steroids after three months of dupilumab therapy. Conclusions: Dupilumab is an emerging biological therapy with promising benefits in the treatment of refractory AFRS. It can be used if functional endoscopic sinus surgery and steroid treatment do not improve symptoms.

Allergic fungal rhinosinusitis linked to other hyper-IgE syndromes through defective TH17 responses

BackgroundIn a gene expression analysis comparing sinus mucosa from allergic fungal rhinosinusitis (AFRS) to that from non-AFRS chronic rhinosinusitis with nasal polyp (CRSwNP) subjects, the antimicrobial peptide (AMP), histatin 1 (HTN1), was found to be the most differentially down-regulated gene in AFRS. ObjectiveTo identify the molecular etiology of the down regulated expression of HTN1 MethodsWe used RT-PCR to compare the expression of AMPs and utilized a fungistasis assay to evaluate the anti-fungal activity of sinus secretions. Using flow cytometry, we characterized the presence of Th17/22 cells and STAT signaling from AFRS, non-AFRS CRSwNP patients, and healthy controls. ResultsWe confirm the decreased expression of AMPs in AFRS sinus mucosa with concordant decrease in antifungal activity in sinus secretions. We show that IL-22 and IL-22-producing T cells are deficient within sinus mucosa of AFRS subjects. In vitro studies demonstrated a defect in IL-6/STAT3 signaling critical for TH17/TH22 differentiation. Epithelial cells from AFRS patients could express AMPs when stimulated with exogenous IL-22/IL-17 and circulating Th17 cell abundance was normal. ConclusionSimilar to other hyper-IgE syndromes, but distinct from CRSwNP, AFRS patients express a defect in STAT3 activation limited to IL-6-dependent STAT3 phosphorylation that is critical for Th17/TH22 differentiation. This defect leads to a local deficiency of IL-17/IL-22 cytokines and deficient AMP expression within diseased sinus mucosa of AFRS patients. Our findings support evaluation of therapeutic approaches that enhance airway AMP production in AFRS.

Primary Radical Extended Sinus Surgery for Management of Extensive Allergic Fungal Rhinosinusitis

Introduction: Allergic fungal rhinosinusitis (AFRS), a subset of sinusitis secondary to hypersensitivity, is clinically similar to chronic rhinosinusitis with nasal polyp but histologically different with rich eosinophils and Charcot Leyden crystals. Since the primary pathology in AFRS is immune mediated, the recurrence rates are high. In this study, we describe the application of radical extended sinus surgery (RESS) as the surgical technique with the usage of postoperative high-volume steroidal nasal irrigation and short-term oral steroid therapy – a threefold strategy – for the prevention of recurrence of this disease. Materials and Methods: A retrospective surgical chart audit of patients diagnosed with AFRS and treated between January 2012 and December 2019 was done. The clinical findings and postoperative outcomes performed by a single senior surgeon in a tertiary referral institution were extracted and analyzed. Results: Of the 17 patients, 88% of patients were immunocompetent and Lund Mackay (LM) of 24, 16 patients had Grade 3 nasal polyps, except one with Grade 1 nasal polyps and an LM score of 8. All patients underwent RESS and received postoperative high-volume topical steroid irrigation with oral steroids in the immediate postoperative period and on follow-up, if recurrence was noted, none required revision surgery. Conclusions: A three-fold strategy is beneficial in the management of AFRS-RESS followed by oral steroids during the immediate postoperative period along with long-term topical high-volume steroid nasal irrigation.

Endoscopic Sinus Surgery in the Management of Inflammatory Sinonasal Disease

Background: Inflammation of the nose and paranasal sinus is a clinical problem frequently encountered in the practice of otolaryngology in our country. Endoscopic sinus surgery is a minimally invasive technique for the evaluation and treatment of inflammatory sinonasal disease. Endoscopic sinus surgery is used to restore sinus ventilation and normal function of sinuses.Objectives: To see the outcome of endoscopic sinus surgery associated with inflammatory sinonasal diseases.Materials and Methods: It is a prospective observational study carried out in ENT &amp;Head Neck Surgery of Shaheed Suhrawardy Medical College Hospital Dhaka from April 2016 to September 2016.Fifty(50) patients were enrolled in this study. Data was collected by Structural Questionnaire.Result: The majority of patients were 21-30years age group. The mean age group was 35.32 years, Male: male-to-female ratio was 1.3:1. The Majority of cases were antrochoanal polyps followed by an ethmoidal polyp, chronic maxillary sinusitis, and fungal rhinosinusitis. The majority of patients came with nasal obstruction and nasal discharge. Polyp was found in the majority of cases. A major complication was found in hemorrhage. Symptomatic improvement was found following endoscopic sinus surgery. KYAMC Journal Volume: 14, No: 04, January 2024: 226-233.

Allergic Fungal Rhinosinusitis and Contralateral Chronic Granulomatous Invasive Fungal Sinusitis: A Case Report.

This case report describes rare concomitant allergic fungal rhinosinusitis (AFRS) and chronic granulomatous invasive fungal sinusitis (CGIFS) in a 34-year-old woman with acute lymphoblastic leukemia and graft-versus-host disease (GVHD) post bone marrow transplantation. Initially presenting with rhinorrhea and nasal obstruction, the patient was diagnosed with AFRS in the right maxillary sinus, followed by a postoperative course of CGIFS in the left nasal cavity, showcasing the unique occurrence. She was not immunocompromised during diagnosis. CGIFS may have occurred because of surgery; however, voriconazole led to significant improvement. This case highlights noninvasive and invasive fungal infections in patients with chronic rhinosinusitis and a history of GVHD and underscores the complexity of diagnosing and managing such cases.

Contemporary Management of Pediatric Invasive Fungal Rhinosinusitis

Contemporary Management of Pediatric Invasive Fungal Rhinosinusitis

Serum Aspergillus fumigatus-Specific IgG as a Complementary Biomarker in Differentiating Endotypes of Chronic Rhinosinusitis: A Study on Its Role and Diagnostic Efficacy in Type 2 Inflammation.

Aspergillus is one of the most common pathogens causing fungal allergy in the respiratory tract. Serum Aspergillus fumigatus-specific immunoglobulin G (Af-sIgG) levels have been used as a biomarker for the diagnosis and treatment response monitoring in airway allergic diseases such as allergic bronchopulmonary aspergillosis and allergic fungal rhinosinusitis. However, its role in common primary chronic rhinosinusitis (CRS) was unclear. This study aims to evaluate whether serum Af-sIgG level could serve as a biomarker for the disease presentation of primary CRS. We obtained serum Af-sIgG levels from patients diagnosed as bilateral primary CRS refractory to medical treatment and evaluated the correlations between serum Af-sIgG levels and disease severity in patients with type 2 (T2) and non-T2 CRS. Patients with T2 CRS exhibited significantly higher serum Af-sIgG levels than non-T2 CRS patients. The cut-off value of serum Af-sIgG in T2 CRS was 20.9 mg/L, with an odds ratio of 3.8 (95% CI 1.17-12.20, P = .026). Furthermore, serum Af-sIgG levels were positively correlated with symptom scores evaluated by the Sino-Nasal Outcome Test-22 (SNOT-22) scores in T2 patients (P = .009). While stratified by SNOT-22 total scores, patients with severe disease had higher serum Af-sIgG levels only in T2 CRS (P = .034). In individual domains of SNOT-22 analysis, serum Af-sIgG levels showed a significant correlation with "ear/facial" symptom scores in the T2 group (P < .001). Serum Af-sIgG levels may serve as a supplementary objective biomarker that correlates with identification and subjective measurements of T2 CRS, and may be associated with symptoms arising from Eustachian tube dysfunction.

Exploring Sociodemographic Factors in Allergic Fungal Rhinosinusitis in a Northern California Patient Population.

Allergic fungal rhinosinusitis (AFRS) is a subtype of chronic rhinosinusitis (CRS) that has previously been associated with younger age and Black patients. However, the role of demographic and socioeconomic factors in AFRS severity remains to be fully elucidated. The objective of this study was to determine whether demographic and socioeconomic factors are associated with incidence of AFRS, as well as with disease severity in Northern California. A retrospective cohort study was conducted of adult patients with AFRS and CRS from 2010 to 2019. AFRS was determined by the Bent and Kuhn criteria, and severity was assessed by radiographic evidence of cranioorbital invasion and other clinical parameters. Chi-square and t-test were used to assess demographic and socioeconomic differences between AFRS and CRS cohorts, and multivariable logistic regression was used to assess risk factors for severe AFRS. Black patients represented 26.2% (55/210 patients) of the AFRS group and 4.9% (842/17,300 patients) of the CRS group, with pairwise comparison of race/ethnicity categories showing that the AFRS group had significantly higher proportions of Black race/ethnicity compared with other race/ethnicities (p < 0.01). AFRS and CRS groups differed significantly by age, with mean ages of 48.7 and 51.0 years, respectively (p = 0.04). There were no significant differences in gender, Medicaid status, comorbidities, and socioeconomic status measures. Multivariate logistic regression showed that Black patients had higher odds of having severe AFRS (adjusted odds ratio = 2.29; 95% confidence interval: 1.18-4.45). AFRS has a unique predilection for Black patients, and severe disease is also more likely in this population.

Manifestation and associated factors of systemic and local allergy among patients with allergic fungal rhinosinusitis: An observational study.

Allergic fungal rhinosinusitis (AFRS) is a subtype of chronic rhinosinusitis, characterized by excessive immune responses to environmental molds or fungi. The diagnosis and classification of AFRS into systemic and local types remain clinically challenging due to overlapping characteristics. This study investigated the prevalence of AFRS, its manifestation and associated factors in systemic and local AFRS. A total of 200 patients diagnosed with fungal rhinosinusitis underwent both skin provocation tests (SPT) and nasal provocation tests (NPT) to confirm AFRS and classify systemic and local types. Patients were considered to have AFRS if either the SPT or NPT was positive. Among these, patients with systemic AFRS were those who had a SPT positive. Local AFRS was when patients had a negative SPT and a positive NPT. Medical history, serum total IgE level, nasal endoscopy examinations, and CT scans were also recorded. Most patients were female (65.8%), with a mean age of 55.6 years (SD = 14.4). Based on the SPT and NPT results, 31% of patients (n = 62) were diagnosed with AFRS. Among these, 54.8% (n = 34) had systemic AFRS, while 45.2% (n = 28) had local AFRS. Patients with AFRS exhibited significantly higher levels of total IgE, eosinophils, and more pronounced signs and symptoms compared to those without AFRS. However, no statistically significant differences were observed between patients with systemic AFRS and those with local AFRS. AFRS was prevalent in our study. Among patients with AFRS, both systemic AFRS and local AFRS were also prevalent. While allergic indicators and clinical presentations can aid in AFRS diagnosis, minimal distinctions were observed between systemic and local AFRS. A comprehensive assessment incorporating both local and systemic allergic responses through provocation tests, such as a combination of skin and nasal tests, is imperative for optimizing AFRS diagnosis and management.

The preliminary application of mNGS in the diagnosis of invasive fungal sinusitis

Objective: By conducting a retrospective analysis of the clinical data of 14 patients diagnosed with invasive fungal rhinosinusitis (IFRS) confirmed by metagenomics next generation sequencing (mNGS) technology, we aim to explore the rapid diagnosis value of mNGS in IFRS. Methods: The clinical data of 14 IFRS patients admitted to TianJin First Central Hospital were retrospectively analyzed from February 2021 to October 2023. The study cohort comprised 8 males and 6 females, with ages ranging from 14 to 77 years. All patients were diagnosed as IFRS by performing mNGS sequencing technology of nasal sinus lesion biopsy specimens. Clinical data such as laboratory examination, imaging examination, histopathological examination results, treatment plan and prognosis were summarized and analyzed. Results: All 14 patients were diagnosed as IFRS, with mNGS detecting pathogens such as Rhizopus (7 cases), Aspergillus (5 cases), Trichoderma (1 case), and Scedosporium apiospermum (1 case). Follow-up evaluations were conducted for a period ranging from 2 months to 2 years post-treatment. At the end of follow-up, 11 out of 14 IFRS patients achieved a complete cure with no signs of recurrence, while the symptoms of the remaining 3 patients significantly improved with comprehensive treatment. Conclusion: mNGS emerges as a highly effective diagnostic tool for IFRS, providing valuable microbiological evidence for clinical diagnosis and demonstrating promising clinical utility.

Aspergillus Sinusitis: Risk Factors and Phenotyping.

Background: Aspergillus can cause fungal rhinosinusitis (FRS). We aimed to identify risk factors for sinonasal Aspergillus disease. Methods: Patients with a positive sinonasal mycological culture for Aspergillus species diagnosed in our hospital located in a continental climate were included in the 9-year retrospective study. Results: Of the 86 patients, 3 had invasive FRS (IFRS), 51 had fungal ball (FB) disease, and 32 had chronic rhinosinusitis with fungus (CFRS). In the IFRS group, all patients had a malignancy and were immunocompromised. Allergies, allergic rhinitis, asthma, nasal polyps, and the use of inhaled and nasal steroids were more common in the CFRS group, and IgE levels were greater than those in the FB and IRFS groups (p < 0.05). Conclusion: FB disease is a relatively symptom-free single-sinus disease among elderly individuals, and IFRS is dominant among immunocompromised patients. We discovered a third patient group, predominantly with nasal polyps, atopy, asthma, and elevated blood IgE and eosinophils, that did not fulfill the allergic FRS (AFRS) criteria. It is possible that a less fulminant category of underdiagnosed AFRS exists in cold climates. Treatment with local debridement is usually sufficient for FRS, apart from IFRS, and relapses are not common in cold climates.

Study of fungal rhinosinusitis among Covid patients at a tertiary care hospital

IntroductionFungal rhinosinusitis (FRS) is being reported with increasing frequency from around the world and has become an important concern in India following the Covid-19 pandemic (Saha et al., 2016). The objectives of the study were to study the clinical and radiological characteristics of fungal rhinosinusitis, and to identify the causative fungal agents in Covid patients. MethodsA cross-sectional, observational study was conducted at a tertiary care hospital for a period of one and a half years from September 2020 to February 2022. Specimen from 105 clinically suspected cases were collected, processed, and identified by KOH, histopathology, and fungal culture as per standard protocols. ResultsOf the total 105 patients, 58 (55.24 %) were diagnosed to have Covid-19 infection. Amongst them, 42 (72.41 %) were confirmed cases of fungal rhinosinusitis. Of the 47 (44.76 %) who did not have Covid-19 infection, 20 (42.55 %) had fungal rhinosinusitis. The significant clinical manifestations observed were nasal obstruction 41 (97.62 %), headache 33 (78.57 %), and nasal discharge 29 (69.05 %). Diabetes mellitus was the major risk factor observed in 36 (85.71 %) of the cases. Maxillary and ethmoid sinuses together were involved in 21 (50 %) cases. Fungi were isolated in 47 of 62 (75.81 %) cases of fungal rhinosinusitis. Aspergillus flavus 13 (22.41 %) was the most common fungi isolated in culture followed by Rhizopus arrhizus 9 (15.52 %). The sensitivity and specificity of KOH were 91.5 % and 74.13 % respectively and that of histopathology were 91.5 % and 94.8 % respectively. ConclusionIn the wake of Covid 19 pandemic, a conjoint collaboration of clinical, radiological, histopathological, and microbiological diagnosis is essential for the proper management of cases.

Biologic Therapies across Nasal Polyp Subtypes.

Chronic rhinosinusitis with nasal polyposis is a common inflammatory condition, with subtypes like aspirin-exacerbated respiratory disease, allergic fungal rhinosinusitis, and central compartment atopic disease sharing a common type 2 inflammatory pathway. Respiratory biologic therapies have been developed that target type 2 inflammation. In this article, we discuss the use of respiratory biologic therapies for nasal polyposis in general, as well as within the various subtypes of nasal polyps. Further, we discuss future roles of novel biologic therapies targeting type 2 inflammation in nasal polyposis.

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.

A Clinico-pathological Study and Management of Fungal Rhinosinusitis

Background: Fungi are ubiquitous in the environment; hence we are constantly exposed to them. Objectives were to know the clinical presentation, radiological and pathological characteristics and management aspects of fungal rhinosinusitis.Methods: 30 cases of fungal rhinosinusitis reported during study period were evaluated and data was collected through history taking, clinical examination, haematological, histopathological and radiological investigations. Management by surgical &amp; medical modalities were evaluated.Results: Fungal rhinosinusitis is more common in 3rd decade of life with male preponderance and more in low socio-economic status (73.3%). Nasal discharge (100%), nasal obstruction (96.7%), chronic headache (90%) and visual disturbances (23.3%) were important clinical features. Sinu-nasal polyp (66.7%) and allergic mucin (40%) were important associated factors. Orbital extension was seen in 33.3%, intracranial extension (20%) and extension to hard palate (6.7%). Computed Tomography scan had a sensitivity of 56.7% while histopathology and potassium hydroxide mount had a sensitivity of 93.33% in detecting cases. Observed mortality rate was 16.6%.Conclusion: Fungal rhinosinusitis is an important clinical entity which must be considered in all patientspresenting with unresolving rhinosinusitis

Decoding the Complexity: A Case Series on Isolated Sphenoid Sinus Fungal Ball.

Fungal rhinosinusitis accounts for a significant portion of paranasal sinus diseases, with fungus ball being the most frequently observed form, constituting 27% of cases. While commonly affecting the maxillary sinus, sphenoid sinus localization occurred in 24.78% of cases. Managing fungal balls in the sphenoid sinus poses challenges because of their proximity to critical structures, necessitating a careful and effective approach. A retrospective analysis was conducted on patients diagnosed with a paranasal sinus fungal ball, specifically isolated sphenoidal localization. Trans-nasal sphenoidotomy was performed, and the patients were followed up postoperatively for recurrence or residual disease. Among four identified cases, headache was the predominant symptom, and all patients underwent successful endoscopic surgery without complications. The follow-up revealed no recurrence or residual disease. Fungal ball in the sphenoid sinus, although uncommon, present diagnostic challenges with symptoms that often mimic other conditions. CT scans play a crucial role in diagnosis and reveal dense masses with characteristic features. Surgical intervention, particularly endoscopic sphenoidotomy, remains the primary and successful treatment, emphasizing the importance of early detection. This study emphasizes the effectiveness of endoscopic sphenoidotomy for managing isolated sphenoid sinus fungal ball. This also highlights the importance of early detection and treatment to prevent complications. Headache, a primary symptom, was successfully resolved after surgery, reinforcing the role of surgery as the primary treatment.

The changing trend of fungal infection in invasive rhinosinusitis in the COVID era.

SARS-COV virus operates as a significant risk factor for invasive fungal aspergillosis and mucormycosis. Successful management of this fulminant infection requires early recognition of the disease and aggressive medical or surgical interventions to prevent the high morbidity and mortality associated with the disease process. 1. To isolate and identify different species of fungi among acute rhinosinusitis patients. 2. To assess the association of risk factors causing fungal rhinosinusitis. 3. To assess the changing trend in fungal rhinosinusitis during the COVID era. This is a retrospective observational study conducted from May 2020 to October 2022, attending the ENT department and relevant data were collected from the medical records department of ABVIMS and Dr RML Hospital, New Delhi, a Tertiary Care Referral Centre in India. The major risk factors studied were age, gender, COVID-19 infection and underlying diseases (such as diabetes mellitus, ischaemic heart disease, hypertension, malignancies, chronic kidney DISEASES, etc.); details of corticosteroid use of all patients were recorded in the datasheet. The pandemic data was divided into three distinct time periods/waves/eras, i.e., first, second, and third waves, each of which included ten months, to examine the changing trend in fungal rhinosinusitis in the pandemic era of COVID-19. A total of 412 patients out of which 236 patients were clinically diagnosed with fungal sinusitis based on revised EORTC criteria. The most common site involved was the orbit with paranasal sinus and eye 86/236 (36.4%), followed by involvement of nasal and paranasal sinus alone 68/236 (28.8%). The most prevalent age range affected was 40 to 50 years. The most commonly associated comorbidity was diabetes mellitus (DM) in 176 (74.5%), followed by head and neck malignancies in 22 (9.32%) patients. Thirty-eight (50.6%) Rhizopus species and 18 (24%) Aspergillus flavus were the most common isolated fungal species on culture, followed by Mucor spp. 14 (18.6%) and Aspergillus fumigatus 5 (6.6%) in the period. In the second wave of COVID, there was a surge in Zygomycetes cases 36 (45%) and after the second wave, the Aspergillus cases increased by 14 (19%) during Jan-Oct 2022. With the continuing coronavirus pandemic, there is an unprecedented and discernible rise in the prevalence of acute invasive fungal sinusitis certainly a spike in cases of Aspergillus infection was observed, probably due to unprecedented usage of Amphotericin B for the treatment of mucormycosis during the third wave This underlines the importance of the need to tailor our treatment protocol as per the etiological agents hence the right antifungal drugs combined with urgent surgical procedures on a case-to-case basis may certainly increase the chances of survival.

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.