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Rapid Diagnosis and Epidemiology of Fungal Rhinosinusitis in PostCOVID-19 Patients
Mayuri K Bapodra1, Anamika J Navadiya1, Seema N Baxi1
1Department of Pathology, GMC and Sir T Hospital, Bhavnagar, Gujarat, India.
Background:
Fungal rhinosinusitis (FRS) cases are not exiguous for the world. However, their spike as a postCOVID sequelae has alarmed the world, especially India. Adding to the woes is the high mortality rate and poor prognosis associated with acute invasive fungal rhinosinusitis (AIFR) in such immunocompromised patients. In such a scenario, early and precise diagnosis of AIFR is what a patient and physician banks upon. KOH and histopathology are the two frontline investigations for the diagnosis of FRS. Our study aimed at analyzing the cases of FRS by histopathology and comparing these with KOH.
Study Design And Materials And Methods:
Prospective longitudinal study including suspected postCOVID FRS patients over a period of 1.5 months. Their clinical, histopathological, and KOH findings were then correlated.
Results:
About 72.5% clinically suspected fungal infection specimens were found to be positive for fungal elements on histopathology. Of these, only 30 cases were positive by KOH mount. Maximum patients belonged to 40-70 years of age; males (67%) more than females. Sites involved were paranasal sinuses (100%), nasal (88%), and orbital (25%). Histopathology revealed mucormycosis (100%) and aspergillosis (16%). Angioinvasion was identified in 38% of the mucormycosis cases.
Conclusion:
In a state of crisis, when the gold standard for fungal identification i.e., culture can take as many as 21 days for final report and early and judicious antifungal treatment is sine qua non of recovery, histopathology has proved to be better than KOH as far as early and precise diagnosis of fungal elements and their invasion is concerned.
Insights
Histopathology is superior to KOH mounts for the rapid and accurate diagnosis of fungal rhinosinusitis (FRS), especially post-COVID-19. This is crucial for timely treatment and improved outcomes in invasive fungal infections.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Otolaryngology
Background:
- Fungal rhinosinusitis (FRS) cases are increasing globally, with a notable rise as a post-COVID-19 sequela.
- Acute invasive fungal rhinosinusitis (AIFR) presents a high mortality rate, particularly in immunocompromised individuals.
- Early and precise diagnosis of AIFR is critical for effective patient management.
Purpose of the Study:
- To analyze fungal rhinosinusitis cases using histopathology.
- To compare the diagnostic efficacy of histopathology with KOH mounts for FRS.
- To evaluate the role of histopathology in diagnosing post-COVID-19 invasive fungal infections.
Main Methods:
- A prospective longitudinal study was conducted over 1.5 months.
- Suspected post-COVID-19 FRS patients were included.
- Clinical, histopathological, and KOH findings were correlated.
Main Results:
- Histopathology confirmed fungal elements in 72.5% of suspected cases, while KOH mounts were positive in only 30 cases.
- The most common age group affected was 40-70 years, with a higher prevalence in males (67%).
- Histopathology revealed mucormycosis (100%) and aspergillosis (16%), with angioinvasion noted in 38% of mucormycosis cases.
Conclusions:
- Histopathology offers a faster and more precise diagnosis of fungal elements and angioinvasion compared to KOH mounts.
- In critical situations where fungal culture takes up to 21 days, histopathology is vital for initiating prompt antifungal treatment.
- Histopathology is a superior diagnostic tool for acute invasive fungal rhinosinusitis, especially in the context of post-COVID-19 complications.
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