Covid-19-Related Acute Invasive Fungal Sinusitis: Clinical Features and Outcomes

Acute invasive fungal rhinosinusitis in post-COVID-19 patients in Vietnam

BACKGROUND

Acute invasive fungal rhinosinusitis (AIFR) is a potentially lethal infection commonly found in immunocompromised patients. It is considered the most aggressive subtype of fungal sinusitis and can lead to severe morbidity and mortality. There was a significant increase in the incidence of AIFR in post-COVID-19 patients compared to AIFR cases before the COVID-19 pandemic. This study aimed to describe the clinical presentation of AIFR associated with COVID-19 illness.

METHODS

A retrospective study included 22 patients diagnosed with AIFR with a recent COVID-19 infection.

RESULTS

The most frequent disease associated with AIFR was diabetes mellitus (95.5%). The mycological analysis identified infection caused by Aspergillus species in 72.7% of patients. Along with stabilizing hemodynamic parameters and controlling any comorbidities, all patients in the present study underwent combined surgical debridement followed by antifungal medications. The overall survival rate was 72.7%. The chance of developing a fatal outcome was significantly higher if meningitis presented initially (odds ratio 35.63, p < 0.05).

CONCLUSION

The presence of meningitis upon initial diagnosis is related to a significantly higher chance of developing a fatal outcome and should be considered, especially in AIFR patients previously treated for COVID-19 infections. Early diagnosis, early use of antifungal agents, aggressive surgical debridement, and control of comorbid conditions remain crucial in managing AIFR.

LEVEL OF EVIDENCE: 4

SARS-CoV-2 Infection (COVID-19) and Rhinologic Manifestation: Narrative Review

Patients with severe pneumonia of unknown etiology presented in December 2019 in Wuhan, China. A novel coronavirus, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), was isolated from the respiratory tracts of these patients. The World Health Organization (WHO) defined respiratory diseases due to SARS-CoV-2 infection as coronavirus disease 2019 (COVID-19). Many researchers have reported that the nasal cavity is an important initial route for SARS-CoV-2 infection and that the spike protein of this virus binds to angiotensin-converting enzyme 2 (ACE2) on epithelial cell surfaces. Therefore, COVID-19 is thought to significantly affect nasal symptoms and various rhinological diseases. In this review, we summarize the association between COVID-19 and various rhinological diseases, such as olfactory dysfunction, rhinosinusitis, and allergic rhinitis.

Invasive Fungal Sinusitis During Active COVID-19 Infection

This case study demonstrates a 58-year-old female who contracted COVID-19 post-vaccination presenting with severe left-sided facial pain, headaches, and dyspnea. A computed tomography was ordered and showed acute sinusitis, and upon bedside endoscopy, the patient was shown to have necrosis of the left-sided middle turbinate with no discoloration, palate necrosis, or facial changes. All samples of the necrotic tissue were reported to be invasive fungal sinusitis. The entire turbinate was resected in the operating room and ethmoid, frontal, and maxillary sinuses were healthy. Chest x-rays post-operatively showed pulmonary effusions and edema although the patient was not stable enough for a lung examination to rule out a pulmonary fungal infection. A bedside endoscopy showed no further necrosis post-operatively although a repeat endoscopy showed duskiness at the lateral attachment of the basal lamella right at the most posterior resection of the middle turbinate. The patient was placed on multiple antifungal agents. The patient remained in hypoxemic respiratory failure and septic shock while on pressors and 2 weeks following this, expired. Post-COVID-19 patients have been shown in the literature to have an increased risk of developing invasive fungal sinusitis (IFS) and all IFS cases during active COVID-19 infection have had a 100% mortality rate.