Coinfection by Aspergillus and Mucoraceae Species in Two Cases of Acute Rhinosinusitis as a Complication of COVID-19

Abstract

Acute invasive fungal rhinosinusitis (AIFR) is a life-threatening infection often found in immunocompromised patients. In the COVID-19 era, reports of AIFR have emerged, with high mortality and morbidity rate. This paper presents two cases of COVID-19 associated AIFR with the combined proven fungal etiology of Aspergillus flavus and Rhizopus arrhizus in case 1 and Aspergillus fumigatus and Rhizopus arrhizus in case 2. Both patients received liposomal amphotericin B then posaconazole combined with aggressive surgical debridement of necrotic tissues with a favorable clinical outcome. Mixed etiology AIFR can influence the outcome; hence, further studies are required upon this new threat.

Is low dose of liposomal amphotericin B effective in management of acute invasive fungal rhinosinusitis? Our conclusions from Al-Mowassat University Hospital, Syria: a prospective observational study

“…Few cases have been reported in the literature with favorable clinical outcomes [32]. Tabarsi et al reported two cases of AIFRS with Mucor and Aspergillus co-infection and the two patients survived without recurrence on follow-up [32]. Of our cases, three of them showed co-infection with Mucor and Aspergillus.…”

“…Mucor and Aspergillus co-infections are rare entities. Few cases have been reported in the literature with favorable clinical outcomes [32]. Tabarsi et al reported two cases of AIFRS with Mucor and Aspergillus co-infection and the two patients survived without recurrence on follow-up [32].…”

Two Adults with Rhinosinusitis Fungal Infection Post COVID-19 in A Lebanese Hospital: Case Report

“…Rhino-sinusitis and pulmonary aspergillosis are the most commonly affected sites of invasive aspergillosis (Tabarsi et al, 2022;Jain and Taneja, 2021). Early diagnosis of invasive aspergillosis by imaging (CT or MRI) and histological examination, typically displaying hyphae that branch at 45 angle, can improve prognosis and decrease morbidity rate (Jain and Taneja, 2021).…”

“…Acute invasive fungal rhinosinusitis (AIFRS), increasingly being reported post COVID-19 infection in various countries around the world including Iran, USA, Tunisia, India, Australia, Turkey, and the United Kingdom (Tabarsi et al, 2022;Ismaiel et al, 2021), has been notably associated with frequent use of steroids, DM, liver and renal failure, and immunosuppression (Ismaiel et al, 2021). This form of infection has been reported to have high morbidity and mortality rates (18-80%) (El-Kholy et al, 2021).…”

“…Mucor and aspergillus are the two pathogens most commonly affecting patients (El-Kholy et al, 2021; Front Med Case Rep, ISSN: 2582-8142 https://www.jmedicalcasereports.org/ Ismaiel et al, 2021;Baghel et al, 2022). The most frequently encountered symptoms are facial pain, headache, ophthalmoplegia (Tabarsi et al, 2022;El-Kholy et al, 2021;Baghel et al, 2022). Uncontrolled diabetes and hyperglycemia caused by the use of corticosteroids during COVID-19 infection presents a predisposing factor for fungal infection (Garg et 2021).…”