Objectives: An increased incidence of acute invasive fungal sinusitis associated with the recent 28 COVID-19 pandemic has been observed, which is considered a public health concern. This study 29 aims to detect the incidence, risk factors, causative agents, clinical presentations, outcomes, and 30 susceptibility rate of various antifungals. 31
Methods: In this cross-sectional cohort study, a total of 30 patients showing acute invasive 32 fungal rhinosinusitis following a COVID-19 infection were investigated. Histopathological 33 biopsies, culture identification, and molecular confirmation of the causative agents were 34 conducted. The demographic data, risk factors, clinical presentations, treatment regimen and its 35 outcomes, and efficacy of antifungals were listed and analyzed. 36 Results: A total of 30 cases with a mean age of 59.6 ± 11.9 years were included. Diabetes 37 mellitus was the most recorded comorbidity with a rate of 86.7%, whereas most of the patients 38 received corticosteroids. The mycological examination confirmed the existence of Mucor 39 (Rhizopus oryzae) and Aspergillus (Aspergillus niger) in 96.7% and 3.3% of the cases, 40 respectively. Various stages of sinonasal involvement (ethmoid, maxillary, sphenoid, and inferior 41 turbinate) represented 100%, 83.3%, 66.7%, and 86.7% of the cases, respectively. Headache and 42 facial pain, ophthalmoplegia, visual loss, and blindness represented 100%, 66.7%, 90%, and 43 53.3% of the cases, respectively. All the cases were simultaneously treated with surgical 44
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debridement and amphotericin B. Moreover, R. oryzae was susceptible to it, whereas A. niger 45 was sensitive to voriconazole, resulting in a survival rate of 86.7% (26/30). The R. oryzae and 46 A. niger isolates were proven to be sensitive to acetic acid, ethyl alcohol, formalin, and isopropyl 47 alcohol. 48
Conclusions: In patients with COVID-19, the diagnosis of acute invasive fungal sinusitis and 49 prompt treatment with antifungal medicine and surgical debridement are important in achieving 50 better outcomes and survival rates. |
