Increased acute invasive fungal rhinosinusitis in COVID-19 patients

Year 2023, Volume: 6 Issue: 3, 656 - 661, 31.05.2023

Serap Bulut Çöbden , İbrahim Özcan , Altan Kaya , Yunus Kantekin , Serkan Altıparmak , Mustafa Alkaya , Ali Bayram , Hafize Sav

https://doi.org/10.32322/jhsm.1282286

Abstract

Aim: Acute invasive fungal rhinosinusitis (AIFRS) is a rare infection of the nose and paranasal sinuses that can be fatal. Infection may lead to tissue infarction, necrosis, and thrombosis and rapidly spread intracranially. The aim of this study is to highlight the increasing cases of AIFRS after covid-19 and to investigate the parameters affecting mortality.
Material and Method: Total 11 patients diagnosed with AIFRS after COVID-19 were included in this study. Patient age, gender, comorbid diseases, initial symptoms, time between COVID-19 diagnosis and AIFRS diagnosis, intensive care hospitalization history, medical treatments, surgical findings, antifungal treatment, fungal species grown in culture, mortality, and the relationships of these parameters with mortality were also evaluated.
Results: A total of 11 patients diagnosed with AIFRS after COVID-19 were included in the study. Among these patients, 81.8% were male, 18. 2% were female, and ages ranged from 57 years to 89 years. The mean time between COVID-19 infection and development of IFRS in patients was 26.09±18.04 days. The initial symptoms in 45.45% of the patients were unilateral periorbital edema, vision loss, and total ophthalmoplegia. The surgical approach was purely endoscopic in all patients. In our study, the mortality rate was 72.7% in COVID-19 related AIFRS patients.
Conclusion: As a result, in our study, we found an increase in AIFRS incidence and mortality due to the systemic effects of COVID 19 and the treatments used for it. AIFRS should be suspected when a patient presents acute sinusitis symptoms after COVID-19 infection.

Keywords

COVID-19, Mucor, AIFRS, ophtalmoplegia

References

• Chang C, Gershwin ME, Thompson GR, III. Fungal disease of the nose and sinuses: an updated overview. Curr Allergy Asthma Rep 2013; 13: 152-61.
• Shanbag R, Rajan NR, Kumar A. Acute invasive fungal rhinosinusitis: our 2 year experience and outcome analysis. Eur Arch Otorhinolaryngol 2019; 276: 1081-7. 
• Fadda GL, Martino F, Andreani G, et al. Definition and management of invasive fungal rhinosinusitis: a single-centre retrospective study. Acta Otorhinolaryngol Ital 2021; 41: 43-50.
• Ergun O, Tahir E, Kuscu O, et al. Retrospective analysis of patients with acute ınvasive fungal rhinosinusitis in a single tertiary academic medical center: a 10-year experience. J Oral Maxillofac Surg 2017; 75: 767.e1-9.
• Singh VP, Bansal C, Kaintura M, Sinonasal Mucormycosis: A to Z. Indian J Otolaryngol Head Neck Surg 2019; 71: S1962–71.
• Montone KT, Livolsi VA, Feldman MA, et al. Fungal rhinosinusitis: a retrospective microbiologic and pathologic review of 400 patients at a single university medical center. Int J Otolaryngol 2012; 2012: 684835.
• Ryu G, Seo MY, Lee KE, et al. Clinical course of rhinosinusitis and efficacy of sinonasal evaluation in kidney transplant recipients: review of 1589 patients. Eur Arch Otorhinolaryngol 2018; 275: 1183-8.
• Fernandez IJ, Crocetta FM, Demattè M, et al. Acute invasive fungal rhinosinusitis in immunocompromised patients: role of an early diagnosis. Otolaryngol Head Neck Surg 2018; 159: 386-93. 
• Wu PW, Huang YL, Yang SW, et al. Acute invasive fungal rhinosinusitis in twenty-one diabetic patients. Clin Otolaryngol. 2018; 43: 1163-7. 
• Musuuza JS, Watson L, Parmasad V, et al. Prevalence and outcomes of co-infection and superinfection with SARS-CoV-2 and other pathogens: a systematic review and meta-analysis. PLoS One 2021; 16: e0251170.
• Feldman C, Anderson R. The role of co-infections and secondary infections in patients with COVID-19. Pneumonia 2021; 13: 1-15.
• Mekonnen ZK, Ashraf DC, Jankowski T, et al. Acute ınvasive rhino-orbital Mucormycosis in a patient with COVID-19-associated acute respiratory distress syndrome. Ophthalmic Plast Reconstr Surg 2021; 37: e40-e80. 
• Waizel-Haiat S, Guerrero-Paz JA, Sanchez-Hurtado L, et al. A case of fatal rhino-orbital Mucormycosis associated with new onset diabetic ketoacidosis and COVID-19. Cureus 2021; 13: e13163. 
• Turbin RE, Wawrzusin PJ, Sakla NM, et al. Orbital cellulitis, sinusitis and intracranial abnormalities in two adolescents with COVID-19. Orbit 2020; 39: 305-10.
• El-Kholy NA, El-Fattah AMA, Khafagy YW. Invasive fungal sinusitis in post COVID-19 patients: a new clinical entity. Laryngoscope 2021; 131: 2652-8. 
• Jestin M, Azoulay E, Pène F, et al. Poor outcome associated with Mucormycosis in critically ill hematological patients: results of a multicenter study. Ann Intensive Care 2021; 11: 31.
• Pan AS, Srinath L, Mucormycosis in a patient with AIDS receiving systemic steroids. J Am Osteopath Assoc 2013; 113: 708-11.
• Najafi N, Kermani F, Gholinejad Ghadi N, et al. Fatal rhinocerebral Mucormycosis in a patient with ulcerative colitis receiving azathioprine and corticosteroid. Curr Med Mycol 2019; 5: 37-41.
• Raizada N, Jyotsna VP, Kandasamy D, et al. Invasive fungal rhinosinusitis in patients with diabetes. J Infect Dev Ctries 2018; 12: 787-93.
• Abdollahi A, Shokohi T, Amirrajab N, et al. Clinical features, diagnosis, and outcomes of rhino-orbito-cerebral Mucormycosis- A retrospective analysis. Curr Med Mycol 2016; 2: 15-23.
• Ismaiel WF, Abdelazim MH, Eldsoky I, et al. The impact of COVID-19 outbreak on the incidence of acute invasive fungal rhinosinusitis. Am J Otolaryngol 2021; 42: 103080.