Management of COVID associated invasive fungal sinusitis.

INTRODUCTION

Mucormycosis is a life-threatening infection caused by fungi belonging to the order mucorales. Aspergillous and Mucormycetes have been reported as the main fungal pathogens for infection in people with COVID-19. The main risk factors include uncontrolled Diabetes mellitus and steroid use.

AIM: The current study aims to analyze the diagnostic indicators, treatment protocols and follow up approach in patients who were affected with post-COVID mucormycosis.

METHODS

Patients who were admitted to Medicover hospitals with acute sinusitis symptoms were included in the study. Data was collected using a structured proforma which included demographic details, past medical history, days of presentation from COVID-19 diagnosis and symptoms related to eyes, nose and mouth. We noted the Magnetic resonance imaging and Computed tomography findings and blood parameters like Total leukocyte count, C-reactive protein, Erythrocyte sedimentation rate, Glycated hemoglobin and creatinine were monitored. All patients were divided into stages and underwent relevant surgical procedures along with, anti-fungal therapy. Follow up was conducted to see for residual or recurrent disease and survival until 1 year post admission.

RESULTS

Total of 23 patients were studied. 17 male and 6 female. 69.5% were diabetic. 91.3% received steroids during COVID treatment. Majority presented within 4 weeks of diagnosis of COVID. CT-SCAN and MRI findings formed the road-map to treatment. All 23 were confirmed mucormycosis based on biopsy reports, but 4 had overlapping Aspergillous infection. All patients were started on amphotericin-B and followed up for disease free status and survival up 1 year. We also monitored CRP levels to declare disease free status.

CONCLUSION

The poor and impaired immune functioning due to COVID infection along with unmonitored use of steroids, was the major cause of rise in mucormycosis. We now know that successful treatment of mucormycosis requires early diagnosis, reversal of underlying predisposing risk factors, surgical debridement and prolonged antifungal therapy.