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. 2024 Feb;76(1):55-63.
doi: 10.1007/s12070-023-04077-6. Epub 2023 Jul 28.

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

Kouser Mohammadi  1 , S M Azeem Mohiyuddin  1 , K C Prasad  1 , Akshaya Rajan  1 , Gopinath Indu Varsha  1 , Arvind Natrajan  1 , Anil K Sakalecha  1 , Diana Ann Jose  1
Affiliations

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

Kouser Mohammadi et al. Indian J Otolaryngol Head Neck Surg. 2024 Feb.

Abstract

The second wave of COVID pandemic was associated with an outbreak of Mucormycosis. The mortality rate of Mucormycosis reaches 50-80% in cases with orbital and intracranial extension (Fadda in Acta Otorhinolaryngol Ital 41:43-50, 2021). In this outbreak we found that few of these patients had bacterial invasive sinusitis mimicking fungal sinusitis. Amphotericin the only effective drug against Mucormycosis is highly toxic and expensive and not indicated in bacterial sinusitis. Our aim was to determine the exact etiologic agent, predisposing factors and outcome of treatment of COVID associated invasive sinusitis presenting with orbital complications. It is a retrospective observational study done in 33 patients with orbital complications in COVID associated invasive sinusitis. Demographic details of the patients and clinical presentation were documented. Rhinological examination was done and a nasal swab was taken for KOH mount along with Gram`s stain and Culture and Sensitivity. All Patients underwent radiological evaluation by contrast enhanced computed tomography (CECT) or MRI. Liposomal Amphotericin B was started. Surgical debridement done. Amphotericin-B was stopped in cases reported negative for fungal elements and antibiotics administered for two weeks. Outcome of treatment was documented. A total of 33 patients were included in the study. 48.5% patients were found to have bacterial infection and 27.3% patient's fungal infections and 24.2% mixed infections.Eschar formation, necrotic tissue, erosion of the lamina papyracea was seen in both Klebsiella (33.3%) and Staphylococcal infections (16.6%) similar to Mucor and mixed infections. Persistent opthalmoplegia and deterioration of vision was associated with Mucor and mixed infections. However improvement in proptosis, ptosis, ophthalmoplegia, and vision was observed in cases associated with bacterial invasive sinusitis. Invasive bacterial sinusitis was under diagnosed during second wave of COVID. Identification of invasive bacterial sinusitis can help in de-escalation of treatment.

Keywords: COVID; Debridement; Invasive sinusitis; Liposomal Amphotericin; Mucor mycosis; Orbital complications.

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Conflict of interest statement

Conflict of interestThe Authors declare that there is no conflict of interest.

Figures

Fig. 1
Fig. 1
Pre-operative presentation with ptosis, proptosis and conjunctival chemosis
Fig. 2
Fig. 2
Coronal CECT image showing (a) thinning of cribriform plate and (b) thinning of lamina papyracea
Fig. 3
Fig. 3
MRI axial image  showing (a) proptosis, (b) retro-orbital fat stranding
Fig. 4
Fig. 4
Image showing post operative residual ptosis
See this image and copyright information in PMC

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