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A Comparative Study of Acute Invasive Fungal Sinusitis During the First and Second Waves of the COVID-19 Pandemic

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Abstract

We aimed to compare the demography, clinical profile, histopathology, fungal culture, radiology, surgery performed, medical therapy and outcomes of patients with acute invasive fungal sinusitis seen during the first and second waves of the COVID-19 pandemic by retrospectively reviewing their case records. Of 238 patients, 43(18.1%) presented during the first wave and 195(81.9%) during the second wave. Patients seen during the first wave were older (p = 0.04) and more likely to have visual impairment (p = 0.004), frozen eye (p = 0.012), altered sensorium (p = 0.007) and stage 3 disease (p = 0.03). Those seen during the second wave were more often COVID-19 positive and had newly diagnosed diabetes mellitus (p = 0.04)and stage 1 disease (p = 0.03). Most patients had a positive culture for Rhizopus species during both waves. Histopathology showed broad aseptate hyphae in all patients but angioinvasion was seen more often during the first wave (p = 0.04). The majority of patients were treated with endoscopic+/- open debridement followed by intravenous amphotericin B and oral posaconazole. While the overall survival rate was similar (first wave 65.1%; second wave 79%; p = 0.106), mortality after discharge was greater during the first wave (11.6% vs 1.5%; p = 0.001). Mortality was higher in patients with stage 3 disease (p = 0.003). Significant differences in clinical presentation, histopathology, radiological stage of disease and post-discharge survival were noted between the two waves of the COVID-19 pandemic, the causes for which were multi-factorial.

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Funding

This study was not funded.

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Authors and Affiliations

  1. Department of Otorhinolaryngology, Christian Medical College, Vellore, 632004, Tamilnadu, India

    Regi Kurien, Lalee Varghese, Lisa Mary Cherian, Ranjeetha Racheal Inja, Manu Thampi, Stuti Chowdhary, Rakesh R Bright, Lisa Abraham, Raga Panicker, Nithya Rajendran & Vedantam Rupa

  2. Department of Emergency Medicine, Christian Medical College, Vellore, 632004, India

    Priya Ganesan

  3. Department of Radiodiagnosis, Christian Medical College, Vellore, 632004, India

    Shalini Sahu & Aparna Irodi

  4. Department of Infectious Diseases, Christian Medical College, Vellore, 632004, India

    Abi Manesh & George M. Varghese

  5. Department of Ophthalmology, Christian Medical College, Vellore, 632004, India

    Jayanthi Peter

  6. Department of Microbiology, Christian Medical College, Vellore, 632004, India

    Joy Sarojini Michael

  7. Department of Pathology, Christian Medical College, Vellore, 632004, India

    Meera Thomas

  8. Department of Biostatistics, Christian Medical College, Vellore, 632002, India

    Reka Karuppusami

Authors
  1. Regi Kurien
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  2. Lalee Varghese
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  3. Lisa Mary Cherian
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  4. Ranjeetha Racheal Inja
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  6. Stuti Chowdhary
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  7. Rakesh R Bright
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  8. Lisa Abraham
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  11. Priya Ganesan
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  12. Shalini Sahu
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  14. Abi Manesh
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  15. Jayanthi Peter
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  16. Joy Sarojini Michael
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  17. Meera Thomas
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  18. Reka Karuppusami
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  19. George M. Varghese
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  20. Vedantam Rupa
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Contributions

The contributions by the authors are Dr Regi Kurien: Conceptualization, Data curation, Methodology, Visualization, Writing – original draft, Writing – review & editing. Dr Lalee Varghese: Conceptualization, Data curation, Methodology, Visualization, Writing – original draft, Writing – review & editing. Dr Lisa Mary Cherian: Conceptualization, Data curation, Methodology, Visualization, Writing – review & editing. Dr Ranjeetha Racheal Inja: Data curation, Methodology, Visualization, Writing – review & editing. Dr Manu Thampi: Data curation, Methodology, Visualization, Writing – review & editing. Dr Stuti Chowdhary: Data curation, Methodology, Visualization, Writing – review & editing. Dr Rakesh.R. Bright: Data curation, Methodology, Visualization, Writing – review & editing. Dr Lisa Abraham: Data curation, Methodology, Visualization, Writing – review & editing. Dr Raga Panicker: Data curation, Methodology, Visualization, Writing – review & editing. Dr Nithya Rajendran: Data curation, Methodology, Visualization, Writing – review & editing. Dr Priya Ganesan: Data curation, Methodology, Visualization, Writing – review & editing. Dr. Shalini Sahu: Data curation, Methodology, Visualization, Investigation, Writing – review & editing. Dr Aparna: Data curation, Methodology, Visualization, Investigation, Writing – review & editing. Dr Abi Manesh: Data curation, Methodology, Visualization, Writing – review & editing. Dr. Jayanthi Peter: Data curation, Methodology, Visualization, Writing – review & editing. Dr Joy Sarojini Michael: Data curation, Methodology, Visualization, Investigation, Writing – review & editing. Dr Meera Thomas: Data curation, Methodology, Visualization, Investigation, Writing – review & editing. Ms Reka Karuppusami: Data curation, Methodology, Data analysis, Visualization, Investigation, Writing – review & editing. Dr. George M. Varghese: Data curation, Methodology, Visualization, Writing – review & editing. Dr Vedantam Rupa: Conceptualization, Data curation, Formal analysis, Methodology, Visualization, Writing – original draft, Writing – review & editing; corresponding author.

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Correspondence to Vedantam Rupa.

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Kurien, R., Varghese, L., Cherian, L.M. et al. A Comparative Study of Acute Invasive Fungal Sinusitis During the First and Second Waves of the COVID-19 Pandemic. Indian J Otolaryngol Head Neck Surg 76, 611–619 (2024). https://doi.org/10.1007/s12070-023-04226-x

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