Septal perforation & nose the most common presenting site in post covid 19 invasive fungal rhinosinusitis: our experience

INTRODUCTION: Nasal cavity is a favourable site for the growth of fungus in immunocompromised individuals due to humid conditions. There was a sudden emergence of acute invasive fungal infection cases in the second wave of the COVID-19 in India. In the present epidemic, the aggressive nature of the disease in immunocompromised patients leads to the bony septal involvement resulting in non-iatrogenic perforation. The most common nasal sites involved in IFI post-COVID-19 infection were middle turbinate followed by middle meatus and then septum. Post-COVID-19 infection in hospitalised patients who received oxygenation greatly exceeded those who were on room air and did not require oxygenation. MATERIALS & METHODS: The objective of this study was to analyse surgically, the most common nasal sites involved by Invasive fungal infections (IFI) in patients who had history of COVID-19 infection & received either of the steroids, immunosuppressive drugs, oxygen or all the three. 120 patients, admitted in the specialised IFI ward of this hospital with a history of COVID-19 infection, gave their consent for inclusion in the study. Patients with no history of COVID-19 infection were excluded from the study. Moreover, patients who did not receive any of the following; Inj. MPS, Inj. Remdesivir / Inj. Tocilizumab and Oxygen for COVID-19 treatment were excluded from the study. The nasal & extra-nasal sites involved by IFI were analysed & documented intra-operatively by the surgeon. All the intra-operative findings were recorded in real-time and saved on the storage device for feedback. Consequently, all the nasal & extra- nasal sites involved by IFI and amenable to surgery, were surgically debrided. Post-op MRI was done after 6 weeks. Second look DNE / debridement was done once the microbiology, HPE and MRI reports were available. Data from all the 120 patients was analysed and most common nasal sites involved by the disease were established. CONCLUSION: To the best of our knowledge, this is the first study to identify nasal septum presenting as perforation plus other nasal sites as the most common nasal site invaded by the IFI in post-COVID-19 patients; which proves that there are multiple nasal sites involved by the fungus in patients who receive oxygen, steroids, immunosuppressive drugs and has one or more underlying co-morbidity.