Fungal Rhinosinusitis in the COVID-19 Era

Hassan, Anas Ahmed; Baher, Maged Mahmoud; Fayed, Ashraf Lotfy; Elsawy, Mohamed Fathy; Aboelenin, Ahmed Yehia; Aboelmaaty, Ahmed Refaat Mahmoud

doi:10.21608/ijma.2024.248768.1870

Fungal Rhinosinusitis in the COVID-19 Era

Document Type : Original Article

Authors

¹ Department of Otorhinolaryngology, Armed Forces College of Medicine, Cairo, Egypt.

² Department of Otorhinolaryngology, Military Medical Academy, Cairo, Egypt.

³ Department of Otorhinolaryngology, Armed Forces College of Medicine, Cairo, Egypt

10.21608/ijma.2024.248768.1870

Abstract

Background: Mucormycosis, a rare fungal infection due to exposure to Mucor. In the era of COVID-19 pandemic, its incidence showed significant increase. The characteristic phenotype of the growth of hyphae in mucormycosis is in and around the blood vessels, leading to life-threatening scenarios, specifically in severely immune-compromised patients. The primary reason facilitating Mucorales spores to germinate in people with COVID-19 is an ideal environment of low oxygen, high glucose, high iron levels, and decreased phagocytic activity of white blood cells due to immunosuppression.
The Aim of the work: This work aimed to describe the clinical characteristics, risk factors, and prognosis of patients with mucormycosis associated with COVID-19, as well as to identify the prevalence of DM and other risk factors among COVID-19-linked fungal rhinosinusitis.
Patients and Methods: A cross-sectional study conducted at the Ear, Nose, and Throat [ENT] departments in military hospitals between September 2021 and April 2022. The study included 18 eligible cases of COVID-19-associated mucormycosis. Laboratory investigations and imaging modalities were used to determine the clinical characteristics and outcomes of the disease.
Results: The mean age of participants was 42.5 years and 67% were males. Most patients suffered from diabetes mellitus [DM] type 2 [83%], while 44% were on immunosuppressive therapy. Half of the patients developed rhino-orbital mucormycosis. Only 11% of the patients improved, while 44% died during follow-up.
Conclusion: Mucormycosis seems to be a serious complication of COVID-19 in high-risk patients. Poor control of diabetes mellitus [DM] might be an important predisposing factor for COVID-19-associated mucormycosis.

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