Invasive fungal sinusitis seen in Indian diabetes patients post COVID-19: Study

The authors reported the following findings:

• The incidence of invasive fungal disease was 26.7% (14.1% were aspergillosis, and 12.6% were yeast infections like Candida).
• The overall mortality rate was 38%, 53 and 31% in patients with and without the fungal disease.
• The mortality rate was reduced using antifungal therapy [mortality: 38.5% in patients receiving treatment vs 90% in patients not receiving therapy].
• The use of corticosteroids and a history of chronic respiratory disease increased the likelihood of aspergillosis.
• All the admitted patients had some form of cranial nerve involvement in ptosis, impaired vision, ophthalmoplegia, facial nerve palsy, etc. Angio invasive nature of mucormycosis could be evident in the form of necrosis of the soft palate.
• Everyone had poor oral hygiene, three of which developed palatal perforation and necrosis.
• Fungal culture in patients three and four had grown Rhizopus spp. While patient two's culture plate had increased Aspergillus, patient one's culture plate demonstrated visible fungal elements.
• Patients had 1–3 settings of FESS with crust removal and local debridement.
• Patient one had dental extraction, and patient three needed craniotomy and drainage of the right temporal abscess.
• Each patient received around 2.2–3.36 gm of injectable conventional amphotericin B followed by T. voriconazole or T. posaconazole. The patients described above with COVID-19 infection were long-standing diabetics.

"To achieve a therapeutic effect at the lowest dose possible and for the shortest duration necessary, the use of therapeutic agents should be monitored," the authors wrote.

Early surgical interventions like drainage of the abscess, FESS, and debridement of the necrosed part should be instituted early to prevent mortality and morbidity.

Reference:

Ingle C, Goyal A, Hange S. Invasive Fungal Sinusitis in Post-COVID-19 Patients with Diabetes Mellitus. J Assoc Physicians India 2022;70(11):75–78