Acute Invasive Fungal Rhinosinusitis and Coronavirus Disease 2019

Area of Science:

• Mycology
• Infectious Diseases
• Otolaryngology

Background:

• Acute invasive fungal rhinosinusitis, or mucormycosis, is a rare and often fatal opportunistic infection.
• This angioinvasive fungal infection primarily affects immunocompromised individuals, leading to tissue necrosis.
• The association between mucormycosis and coronavirus disease 2019 (COVID-19) has been noted in numerous case reports.

Purpose of the Study:

• To explore potential predisposing factors for mucormycosis in COVID-19 patients beyond established risks like diabetes.
• To highlight the role of factors such as steroid therapy, broad-spectrum antibiotic use, and hospitalization in COVID-19-associated mucormycosis.
• To increase awareness among head and neck surgeons regarding the rising incidence of craniofacial mucormycosis in this patient population.

Main Methods:

• Review of case reports and existing literature on mucormycosis in COVID-19 patients.
• Analysis of potential contributing factors including medical interventions and patient-specific conditions.
• Discussion of pathophysiological mechanisms potentially linking COVID-19 to increased mucormycosis risk.

Main Results:

• Several factors beyond diabetes are implicated in COVID-19-associated mucormycosis.
• Steroid therapy for severe dyspnea, broad-spectrum antibiotic use, and nosocomial infections during hospitalization are significant contributors.
• Increased serum ferritin, endothelial damage, and pancreatic islet effects in COVID-19 patients may also play a role.

Conclusions:

• Head and neck surgeons must recognize the heightened prevalence of craniofacial mucormycosis in COVID-19 patients.
• Early detection and prompt intervention are critical for improving patient outcomes in cases of mucormycosis.
• Understanding these multifactorial risks is essential for managing this severe fungal complication in the context of the COVID-19 pandemic.