Objectives: 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.
Methods: 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.
Results: 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.
Conclusions: 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 |
