Clinicoepidemiological study of acute invasive fungal rhinosinusitis in a tertiary care centre
Keywords:AIFRS, Post covid, Steroid, COVID-19
Background: Coronavirus disease 2019 (COVID-19) accounted for severe acute respiratory syndrome corona virus 2 (SARS-CoV-2), which was declared a global pandemic by World health organization (WHO) in March 2020. In second wave of COVID there was notable surge in Acute invasive fungal rhinosinusitis (AIFRS). We observed that use of systemic corticosteroids in treatment of COVID 19 especially among patients with poorly controlled diabetes mellitus increased the incidence of AIFRS.
Methods: This is retrospective observational study carried out in a Tertiary care Hospital GMC Akola from period of February 2021 to august 2021 were patients with the suspected diagnosis of AIFRS were admitted and evaluated following a standardized protocol, including clinical examination diagnostic nasal endoscopy, radiological evaluation. Diagnosis of AIFRS was confirmed on histopathology.
Results: Study was conducted in GMC, Akola of 136 patients out of which 97 were males and 39 were females. In our study 78.67% patients had history of covid infection, followed by diabetes mellitus in 54.41%, history of steroid treatment found in 64.70% patients. On HPE 69.85% were positive for mucor and mixed infection (mucor and aspergillus) were found in 6.61%. Most common presenting feature was facial pain and swelling in 66.91%, palatal changes with dental pain in 45.58%, diminution of vision 17.64%, headache in 27.94% patients.
Conclusions: Early and prompt diagnosis in high level of clinical suspicion in suspicious patient of AIFRS is vital to improve outcomes as it is known to have high morbidity and mortality (18-80%).
Werthman-Ehrenreich A. Mucormycosis with orbital compartment syndrome in a patient with COVID-19. The American journal of emergency medicine. 2021;42:264-e5.
Selarka L, Sharma S, Saini D, Sharma S, Batra A, Waghmare VT, Dileep P et al. Mucormycosis and COVID‐19: An Epidemic within a Pandemic in India. Mycoses. 2021;40:221-4.
Jeong W, Keighley C, Wolfe R. The epidemiology and clinical manifestations of mucormycosis: a systematic review and meta-analysis of case reports. Clin Microbiol Infect. 2019;25:26-34.
Selarka L, Sharma S, Saini D, Sharma S, Batra A,Waghmare VT, Dileep P et al. Mucormycosis and COVID 19,an epidemic within a pandemic in India. Mycoses. 2021;12(3):110-3.
Gillespie MB, O’Malley BW, Francis HW. An approach to fulminant invasive Fungal rhinosinusitis in the immunocompromised host. Arch Otolaryngol Head Neck Surg. 1998;124:520.
Zinreich SJ, Kennedy DW, Malat J, Curtin HD, Epstein JI, Huff LC et al. Fungal sinusitis: diagnosis with CT and MR imaging. Radiology. 1988;169:439-44.
Aribandi M, McCoy VA, Bazan C 3rd. Imaging features of invasive and noninvasive fungal sinusitis: a review. Radiographics. 2007;27:1283-96.
Reddy CE, Gupta AK, Singh P. Imaging of granulomatous and chronic invasive fungal sinusitis: comparison with allergic fungal sinusitis. Otolaryngol Head Neck Surg. 2010;143:294-300.
Nicolai P, Lombardi D, Tomenzoli D, Villaret AB, Piccioni M, Mensi M et al. Fungus ball of the paranasal sinuses: experience in 160 patients treated with endoscopic surgery. Laryngoscope. 2009;119:2275-79.
deShazo RD, O’Brien N, Chapin K, Soto-Aguiar M, Gardner L, Swain R. A new classification and diagnostic criteria for invasive fungal sinusitis. Arch Otolaryngol Head Neck Surg. 1997;123:1181-8.
Ghadiali MT, Deckard NA, Farooq U, Astor F, Robinson P, Casiano RR. Frozen-section biopsy analysis for acute invasive fungal rhinosinusitis. Otolaryngol - Head Neck Surg. 2007;136:714-9.
Badiee P, Moghadami M, Rozbehani H. Comparing immunological and molecular tests with conventional methods in diagnosis of acute invasive fungal rhinosinusitis. J Infect Dev Ctries. 2016;10:90-5.
Gillespie MB, O’Malley BW. An algorithmic approach to the diagnosis and management of invasive fungal rhinosinusitis in the immunocompromised patient. OtolaryngolClin North Am. 2000;33:323-33.
Ribes JA, Vanover-Sams CL, Baker DJ. Zygomycetes in human disease. ClinMicrobiol Rev. 2000;13(2):236-301.
Afﬁnati A, Wallia A, Gianchandani R. Severe hyperglycemia and insulin resistance in patients with SARSCov-2 infection: a report of two cases. Clin Diabetes Endocrinol. 2021;7(1):8.
Cox G (2020)Mucormycosis Up To Date (8).
Peeri NC, Shrestha N, Rahman MS, et al. The SARS, MERS and novel coronavirus (COVID-19) epidemics, the newest and biggest global health threats: what lessons have we learned? Int J Epidemiol. 2020;49:717-26.
Valera FC, do Lago T, Tamashiro E, Yassuda CC, Silveira F, Anselmo-Lima WT. Prognosis of acute invasive fungal rhinosinusitis related to underlying disease. International Journal of Infectious Diseases. 2011;15(12):e841-4.
Kasapoglu F, Coskun H, Ozmen OA, Akalin H, Ener B. Acute invasive fungal rhinosinusitis: evaluation of 26 patients treated with endonasal or open surgical procedures. Otolaryngol Head Neck Surg. 2010;143:614-20.
Donnelly JP, Chen SC, Kauffman CA, Steinbach WJ, Baddley JW, Verweij PE, et al. Revision and update of the consensus deﬁnitions of invasive fungal disease from the European organization for research and treatment of cancer and the mycoses study group education and research consortium. Clin Infect Dis. 2020;71(6):1367-76.
Bellazreg F, Hattab Z, Meksi S. Outcome of mucormycosis after treatment:report of five cases. New Microbes New Infect. 2015;6:49-52.
Vaezi A, Moazeni M, Rahimi MT, de Hoog S, Badali H. MucormycosisinIran: a systematic review. Mycoses 2016;59:402-15.
Guan W, Liang W, Zhao Y, Liang H, Chen Z, Li Y, et al. Comorbidity and its impact on 1590 patients with Covid19 in China: a nationwide analysis. EurRespir J. 2020;55(5):2000547.
Shodja M, Knutsen R, Cao J, Oda K, Beeson L, Fraser G, et al. Effects of glycosylated hemoglobin levels on neutrophilic phagocytic functions. Jacobs J DiabetesEndocrinol. 2017;8(2):9-16.
Lecube A, Pachon G, Petriz J, Hernandez C, Simo R. Phagocytic activity is impaired in type 2 diabetes mellitus and increases after metabolic improvement. PLoSONE. 2011;6(8):E23366.
Hodgson K, Morris J, Bridson T, Govan B, Rush C, Ketheesan N. Immunological mechanisms contributing to the double burden of diabetes and intracellular bacterial infections. Immunology. 2015;144(2):171-85.
Bakhshaee M, Bojdi A, Allahyari A. Acute invasive fungalrhinosinusitis: our experience with 18 cases. Eur Arch Otorhinolaryngol. 2016;273:4281-87.
Saedi B, Sadeghi M, Seilani P. Endoscopic management of rhinocerebralmucormycosis with topical and intravenous amphotericin B J LaryngolOtol. 2011;125:807-10.
Ketenci I, Ünlü Y, Kaya H. Rhinocerebralmucormycosis: experience in 14 patients. J LaryngolOtol. 2011;125:e3.
Stiff H, Chung A. Orbital compartment syndrome curriculum. Eyerounds. 2020. Accessed on 25 July 2020.
Payne SJ, Mitzner R, Kunchala S, Roland L, McGinn JD. Acute invasive fungal rhinosinusitis: a 15-year experience with 41 patients. Otolaryngol – Head Neck Surg. 2016;154:759-64.
Parikh SL, Venkatraman G, DelGaudio JM. Invasive fungal sinusitis: a 15-year review from a single institution. Am J Rhinol. 2004;18:75-81.
Talbot GH, Huang A, Provencher M. Invasive aspergillusrhinosinusitis in patients with acute leukemia. Rev Infect Dis. 1991;13:219-32.
Chamilos G, Lewis RE, Kontoyiannis DP. Delaying amphotericin B-based frontline therapy significantly increases mortality among patients with hematologic malignancy who have zygomycosis. Clin Infect Dis. 2008;47:503-9.
Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Foodborne, Waterborne, and Environmental Diseases (DFWED). Available at: https://www.cdc.gov/ncezid/dfwed/ind ex.html. Accessed on 17 May 2021.