Invasive Sinusitis Presenting with Orbital Complications in COVID Patients: Is Mucor the Only Cause?

Area of Science:

• Otolaryngology
• Infectious Diseases
• Ophthalmology

Background:

• The COVID-19 pandemic's second wave saw an increase in Mucormycosis, a fungal infection with high mortality.
• Bacterial invasive sinusitis can mimic fungal sinusitis, complicating diagnosis and treatment.
• Amphotericin B, the primary treatment for Mucormycosis, is toxic, expensive, and ineffective against bacterial infections.

Purpose of the Study:

• To identify the etiologic agents of invasive sinusitis with orbital complications during the COVID-19 pandemic.
• To determine predisposing factors and treatment outcomes for these patients.
• To differentiate bacterial from fungal sinusitis for appropriate therapeutic de-escalation.

Main Methods:

• A retrospective observational study of 33 patients with COVID-associated invasive sinusitis and orbital complications.
• Clinical evaluation, rhinological examination, nasal swabs for microscopy and culture, and radiological imaging (CECT/MRI).
• Treatment included Liposomal Amphotericin B and surgical debridement, with adjustments based on microbiological findings.

Main Results:

• Bacterial infections were identified in 48.5% of patients, fungal infections in 27.3%, and mixed infections in 24.2%.
• Clinical presentations like eschar formation and tissue necrosis were observed in both bacterial and fungal infections.
• Orbital complications, including persistent ophthalmoplegia and vision deterioration, were more associated with fungal and mixed infections, while bacterial sinusitis showed improvement with appropriate antibiotics.

Conclusions:

• Invasive bacterial sinusitis was underdiagnosed during the COVID-19 pandemic.
• Distinguishing bacterial from fungal sinusitis is essential for effective treatment and preventing unnecessary antifungal use.
• Accurate diagnosis allows for targeted antibiotic therapy, leading to better outcomes in COVID-associated invasive sinusitis with orbital complications.