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Acute Invasive Fungal Rhinosinusitis and Coronavirus Disease 2019
Mosaad Abdel-Aziz1, Noha Azab2
1Department of Otolaryngology.
Abstract:
Acute invasive fungal rhinosinusitis (mucormycosis) is a rare, highly fatal disease. This opportunistic fungal infection causes angioinvasion and ischemic tissue necrosis. It mainly affects immunocompromised patients. Since the coronavirus disease 2019 (COVID-19) outbreak, many case reports have described the rhino-orbital-cerebral mucormycosis associated with COVID-19. However, the underlying predisposing factors are unknown. Several factors, other than diabetes, which is the most well-known contributing factor, may be involved in causing this severe fungal infection in COVID-19 patients. These factors may include steroid therapy, which is being used in severely dyspneic patients, the use of broad-spectrum antibiotics that may cause fungal flare-ups, and hospitalization with possible nosocomial infections. In addition, increased serum ferritin levels, possible endothelial damage, and pancreatic islets affection among COVID-19 patients may be implicated. Head and neck surgeons should be aware of the increasing prevalence of craniofacial mucormycosis among COVID-19 patients, as early diagnosis and prompt treatment are essential to improve the outcomes.
Insights
Mucormycosis, a fatal fungal infection, is increasingly seen in COVID-19 patients. Factors beyond diabetes, like steroid use and hospitalization, may increase risk, necessitating early diagnosis.
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.
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