Invasive fungal rhinosinusitis associated with COVID-19: Course changes and prognosis predictors

Maurizio Barbara; Saad Elzayat; Ashraf Lotfy; Luigi Sabino; Giorgio Bandiera; Hossam S Elsherif; Maiada Youssef; Ayman Fouad; Khaled Nasr; Luigi Volpini; Haitham H Elfarargy

doi:10.1016/j.otoeng.2022.11.010

Invasive fungal rhinosinusitis associated with COVID-19: Course changes and prognosis predictors

Acta Otorrinolaringol Esp (Engl Ed). 2023 Jul-Aug;74(4):243-252. doi: 10.1016/j.otoeng.2022.11.010. Epub 2022 Nov 29.

Authors

Affiliations

¹ ENT Clinic, NEMOS Department, Sant Andrea University Hospital, Sapienza University, Rome, Italy.
² Otolaryngology Department, Kafrelsheikh University, Kafrelsheikh, Egypt.
³ Otolaryngology Department, El-Galaa Military Hospital, Egypt.
⁴ Otolaryngology Department, Tanta University, Tanta, Egypt.
⁵ Ophthalmology Department, Kafrelsheikh University, Kafrelsheikh, Egypt.
⁶ Otolaryngology Department, Liverpool University Hospitals NHS Foundation Trust, UK.
⁷ Otolaryngology Department, Kafrelsheikh University, Kafrelsheikh, Egypt. Electronic address: hitham_elfrargy@med.kfs.edu.eg.

PMID: 36460059
DOI: 10.1016/j.otoeng.2022.11.010

Abstract

Background: This study aimed to analyze the behavior of acute invasive fungal rhinosinusitis (AIFRS) associated with COVID-19 infection as there has been an increase in the rate of AIFRS cases in the last two years, and many reports connected this rising with the COVID-19 infection. We studied most factors that may impact the prognosis as a trial to find the most affecting factors to improve the outcomes.

Methods: It was a retrospective observational study that included cases from four tertiary referral institutions between November 2020 to February 2022. We included sixty-six patients who suffered from AIFRS associated with confirmed COVID-19. We observed the prognosis of all included patients with a six-month follow-up. We correlated the prognosis with many factors, such as demographic data, medical conditions, blood investigations, the features of fungal infections, and management.

Results: Forty-two patients (64%) survived after the AIFRS associated with COVID-19, and twenty-two patients (36%) died. High doses of corticosteroids with prolonged use were the main factors that affected the behavior of the AIFRS associated with COVID-19. HbA1c was a good predictor of the prognosis; a level less than 9.35% may indicate survival with 87.5% sensitivity.

Conclusions: According to this multi-center study, the mortality of the AIFRS associated with COVID-19 was high. The behavior was affected by glycemic control, the type of fungal species, and the type of antifungal therapy. Early surgical debridement, a combination of Amphotericin B with Voriconazole, and anticoagulants helped improve the prognosis.

Keywords: Anticoagulantes; Anticoagulants; COVID-19; Corticoides; Corticosteroids; DM; Invasive fungal rhino-sinusitis; Prognosis; Pronóstico; Rinosinusitis fúngica invasiva.