Early Diagnosis, Treatment Essential in Acute Invasive Fungal Sinusitis in Patients with Recent COVID-19 Infection

by Linda Kossoff •

What can be learned about invasive fungal respiratory superinfections and their management in patients with COVID-19?

BOTTOM LINE

Clinical suspicion of acute invasive fungal rhinosinusitis (AIFR) among COVID-19 patients and early management with antifungal therapy and surgical debridement is essential for better outcomes and higher survival.

BACKGROUND: AIFR is an aggressive, time-sensitive, and potentially fatal subtype of fungal sinusitis that is notably found in immune-compromised patients. The reported most frequently affected individuals include those with malignancy, uncontrolled diabetes, AIDS, immunosuppressive and chemotherapeutic drugs, and, recently, COVID-19.

STUDY DESIGN: Longitudinal prospective study.

SETTING: Department of Otorhinolaryngology–Head and Neck Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt.

SYNOPSIS: Researchers analyzed 36 patients diagnosed with AIFR associated with a recent COVID-19 infection and treated at a single institution between August 2020 and December 2020. Computed tomography scans and magnetic resonance venography was obtained. Biopsy results confirmed that the main causative fungi were Mucor species (77.8%) and Aspergillus fumigatus (30.6%). The most common associated diseases were diabetes mellitus (27.8%) and hypertension (16.67%). Common presenting symptoms were headache and facial pain (75%), facial numbness (66.7%), and ophthalmoplegia and visual loss (63.9%). All patients received combined antifungal therapy and surgery except for two, who were maintained on antifungal therapy only. (Only PCR-negative patients for COVID-19 were surgically treated.) Most patients (26) received intravenous liposomal amphotericin B (80.56%). Overall survival was 63.89% (23/36). Eight patients died from extensive intracranial extension, two from uncontrolled renal failure, two with continuous severe respiratory failure, and one with uncontrolled leukemia. Authors stress the need for early diagnosis of AIFR to improve treatment outcomes. Study limitations included relatively limited patient numbers and short-term follow-up.

CITATION: El-Kholy NA, El-Fattah AMA, Khafagy YW. Invasive fungal sinusitis in post COVID-19 patients: a new clinical entity. Laryngoscope. 2021;131:2652-2658