Clinical and mycological investigations of post‐COVID‐19 acute invasive fungal sinusitis

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Abstract

Objectives

An increased incidence of acute invasive fungal sinusitis associated with the recent COVID‐19 pandemic has been observed, which is considered a public health concern. This study aims to detect the incidence, risk factors, causative agents, clinical presentations, outcomes, and susceptibility rate of various antifungals.

Methods

In this cross‐sectional cohort study, a total of 30 patients showing acute invasive fungal rhinosinusitis following a COVID‐19 infection were investigated. Histopathological biopsies, culture identification, and molecular confirmation of the causative agents were conducted. The demographic data, risk factors, clinical presentations, treatment regimen and its outcomes, and efficacy of antifungals were listed and analyzed.

Results

A total of 30 cases with a mean age of 59.6 ± 11.9 years were included. Diabetes mellitus was the most recorded comorbidity with a rate of 86.7%, whereas most of the patients received corticosteroids. The mycological examination confirmed the existence of Mucor ( Rhizopus oryzae) and Aspergillus ( Aspergillus niger) in 96.7% and 3.3% of the cases, respectively. Various stages of sinonasal involvement (ethmoid, maxillary, sphenoid, and inferior turbinate) represented 100%, 83.3%, 66.7%, and 86.7% of the cases, respectively. Headache and facial pain, ophthalmoplegia, visual loss, and blindness represented 100%, 66.7%, 90%, and 53.3% of the cases, respectively. All the cases were simultaneously treated with surgical debridement and amphotericin B. Moreover, R. oryzae was susceptible to it, whereas A. niger was sensitive to voriconazole, resulting in a survival rate of 86.7% (26/30). The R. oryzae and A. niger isolates were proven to be sensitive to acetic acid, ethyl alcohol, formalin, and isopropyl alcohol.

Conclusions

In patients with COVID‐19, the diagnosis of acute invasive fungal sinusitis and prompt treatment with antifungal medicine and surgical debridement are important in achieving better outcomes and survival rates.

Level of Evidence

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Most cited references 43

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Dexamethasone in Hospitalized Patients with Covid-19 — Preliminary Report

Mark Peters (2021)

Abstract Background Coronavirus disease 2019 (Covid-19) is associated with diffuse lung damage. Glucocorticoids may modulate inflammation-mediated lung injury and thereby reduce progression to respiratory failure and death. Methods In this controlled, open-label trial comparing a range of possible treatments in patients who were hospitalized with Covid-19, we randomly assigned patients to receive oral or intravenous dexamethasone (at a dose of 6 mg once daily) for up to 10 days or to receive usual care alone. The primary outcome was 28-day mortality. Here, we report the preliminary results of this comparison. Results A total of 2104 patients were assigned to receive dexamethasone and 4321 to receive usual care. Overall, 482 patients (22.9%) in the dexamethasone group and 1110 patients (25.7%) in the usual care group died within 28 days after randomization (age-adjusted rate ratio, 0.83; 95% confidence interval [CI], 0.75 to 0.93; P<0.001). The proportional and absolute between-group differences in mortality varied considerably according to the level of respiratory support that the patients were receiving at the time of randomization. In the dexamethasone group, the incidence of death was lower than that in the usual care group among patients receiving invasive mechanical ventilation (29.3% vs. 41.4%; rate ratio, 0.64; 95% CI, 0.51 to 0.81) and among those receiving oxygen without invasive mechanical ventilation (23.3% vs. 26.2%; rate ratio, 0.82; 95% CI, 0.72 to 0.94) but not among those who were receiving no respiratory support at randomization (17.8% vs. 14.0%; rate ratio, 1.19; 95% CI, 0.91 to 1.55). Conclusions In patients hospitalized with Covid-19, the use of dexamethasone resulted in lower 28-day mortality among those who were receiving either invasive mechanical ventilation or oxygen alone at randomization but not among those receiving no respiratory support. (Funded by the Medical Research Council and National Institute for Health Research and others; RECOVERY ClinicalTrials.gov number, NCT04381936; ISRCTN number, 50189673.)

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Remdesivir for the Treatment of Covid-19 — Final Report

John H. Beigel, Kay Tomashek, Lori Dodd … (2022)

Abstract Background Although several therapeutic agents have been evaluated for the treatment of coronavirus disease 2019 (Covid-19), none have yet been shown to be efficacious. Methods We conducted a double-blind, randomized, placebo-controlled trial of intravenous remdesivir in adults hospitalized with Covid-19 with evidence of lower respiratory tract involvement. Patients were randomly assigned to receive either remdesivir (200 mg loading dose on day 1, followed by 100 mg daily for up to 9 additional days) or placebo for up to 10 days. The primary outcome was the time to recovery, defined by either discharge from the hospital or hospitalization for infection-control purposes only. Results A total of 1063 patients underwent randomization. The data and safety monitoring board recommended early unblinding of the results on the basis of findings from an analysis that showed shortened time to recovery in the remdesivir group. Preliminary results from the 1059 patients (538 assigned to remdesivir and 521 to placebo) with data available after randomization indicated that those who received remdesivir had a median recovery time of 11 days (95% confidence interval [CI], 9 to 12), as compared with 15 days (95% CI, 13 to 19) in those who received placebo (rate ratio for recovery, 1.32; 95% CI, 1.12 to 1.55; P<0.001). The Kaplan-Meier estimates of mortality by 14 days were 7.1% with remdesivir and 11.9% with placebo (hazard ratio for death, 0.70; 95% CI, 0.47 to 1.04). Serious adverse events were reported for 114 of the 541 patients in the remdesivir group who underwent randomization (21.1%) and 141 of the 522 patients in the placebo group who underwent randomization (27.0%). Conclusions Remdesivir was superior to placebo in shortening the time to recovery in adults hospitalized with Covid-19 and evidence of lower respiratory tract infection. (Funded by the National Institute of Allergy and Infectious Diseases and others; ACTT-1 ClinicalTrials.gov number, NCT04280705.)

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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): The epidemic and the challenges

Chih-Cheng Lai, Tzu-Ping Shih, Wen-Chien Ko … (2020)

Highlights • Emergence of 2019 novel coronavirus (2019-nCoV) in China has caused a large global outbreak and major public health issue. • At 9 February 2020, data from the WHO has shown >37 000 confirmed cases in 28 countries (>99% of cases detected in China). • 2019-nCoV is spread by human-to-human transmission via droplets or direct contact. • Infection estimated to have an incubation period of 2–14 days and a basic reproduction number of 2.24–3.58. • Controlling infection to prevent spread of the 2019-nCoV is the primary intervention being used.

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Author and article information

Contributors

Samah Mahmoud Eldsouky:

ORCID: https://orcid.org/0000-0002-0746-6108

samahmahmoed83@yahoo.com

Journal

Journal ID (nlm-ta): Laryngoscope Investig Otolaryngol

Journal ID (iso-abbrev): Laryngoscope Investig Otolaryngol

Journal ID (doi): 10.1002/(ISSN)2378-8038

Journal ID (publisher-id): LIO2

Title: Laryngoscope Investigative Otolaryngology

Publisher: John Wiley & Sons, Inc. (Hoboken, USA )

ISSN (Electronic): 2378-8038

Publication date (Electronic): 28 October 2022

Publication date Collection: December 2022

Volume: 7

Issue: 6 ( doiID: 10.1002/lio2.v7.6 )

Pages: 1780-1789

Affiliations

[ ¹ ] Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine Benha University Benha City Egypt

[ ² ] Department of Medical Microbiology and Immunology Benha University Benha City Egypt

[ ³ ] Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine Benha University Benha City Egypt

[ ⁴ ] Department of Clinical and Chemical Pathology, Faculty of Medicine Benha University Benha City Egypt

[ ⁵ ] Department of Internal Medicine, Faculty of Medicine Benha University Benha City Egypt

[ ⁶ ] Department of Bacteriology, Mycology, and Immunology, Faculty of Veterinary Medicine University of Sadat City Sadat City Minufiyaa Egypt

Author notes

[*] [* ] Correspondence

Samah Mahmoud Eldsouky, Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, Benha University, Benha City, Qalyubia 13511, Egypt.

Email: samahmahmoed83@ 123456yahoo.com

Author information

Samah Mahmoud Eldsouky https://orcid.org/0000-0002-0746-6108

Amany K. Shahat https://orcid.org/0000-0001-5303-726X

AL‐Shaimaa M. AL‐Tabbakh https://orcid.org/0000-0001-6637-0387

Yasmin M. Marei https://orcid.org/0000-0002-8370-6812

Lina Abdelhady Mohammed https://orcid.org/0000-0002-6332-2977

Ola Samir El‐Shimi https://orcid.org/0000-0001-8276-8352

Dina Saad Abdelmotaleb https://orcid.org/0000-0002-9345-2553

Yomna Mohammed Marei https://orcid.org/0000-0002-0932-2626

Article

Publisher ID: LIO2956

DOI: 10.1002/lio2.956

PMC ID: 9764791

PubMed ID: 36544940

SO-VID: 0a85b8d7-7eeb-42b2-b9f8-6b5233a95ac0

License:

This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

History

Date revision received : 18 September 2022

Date received : 05 July 2022

Date accepted : 21 September 2022

Page count

Figures: 3, Tables: 3, Pages: 10, Words: 6249

Custom metadata

source-schema-version-number 2.0

cover-date December 2022

details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:6.2.3 mode:remove_FC converted:20.12.2022

Keywords: antifungals,covid‐19,mucormycosis,polymerase chain reaction,sinusitis

Data availability:

Keywords: antifungals, covid‐19, mucormycosis, polymerase chain reaction, sinusitis

Clinical and mycological investigations of post‐COVID‐19 acute invasive fungal sinusitis

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Abstract

Objectives

Methods

Results

Conclusions

Level of Evidence

Related collections

Novel Coronavirus Disease COVID-19

Most cited references 43

Dexamethasone in Hospitalized Patients with Covid-19 — Preliminary Report

Remdesivir for the Treatment of Covid-19 — Final Report

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): The epidemic and the challenges

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