Factors associated with invasive fungal sinusitis in patients with COVID-19: A systematic review and single-center case series

Laryngoscope Investig Otolaryngol. 2022 Jun 15;7(4):913-919. doi: 10.1002/lio2.833. Online ahead of print.


Objective: Invasive fungal sinusitis (IFS) in patients with active or recent COVID-19 have been reported throughout the world. The primary purpose of the systematic review is to describe factors associated with IFS in patients with COVID-19. The goal of the case series was to also characterize these factors in addition to evaluating the incidence of IFS at our institution after the onset of the pandemic.

Methods: A systematic review using the preferred reporting in systematic reviews and meta-analyses (PRISMA) framework identified publications of IFS cases associated with COVID-19 (IFSAC). Search terms were "COVID-19," "invasive," "fungal," and "sinusitis." IFS cases were evaluated for COVID-19 status, fungal etiology, comorbidities, treatment, and outcome. A case series of patients at our center with IFS between December 1, 2018 to March 31, 2020 ("pre-covid") and April 1, 2020 to August 1, 2021 ("post-covid") was also performed with the above parameters.

Results: Fourteen studies totaling 206 cases of IFSAC were identified. Most cases came from India (140/206, 68.0%), followed by Egypt (62/206, 30.1%), and North America (4/206, 1.9%). Diabetes was the most common comorbidity (151/206, 73.3%). Recent or prolonged steroid use was noted in 65.0% of cases (134/206). In our series, five pre-covid and four post-covid cases were identified. One had recent COVID-19 infection. Acute myeloid leukemia was the most common pre-covid comorbidity (3/5, 60.0%). Diabetes was the most frequent post-covid comorbidity (2/4, 50.0%). Chronic steroid usage was noted in two pre-covid and one post-covid cases.

Conclusion: Diabetes and steroid use are common factors in reported cases of IFSAC. IFS incidence in our case series did not change appreciably after the onset of the pandemic.Level of Evidence: 4.

Keywords: COVID‐19; SARS‐CoV‐2; coronavirus; corticosteroids; diabetes; invasive fungal sinusitis; mucormycosis; otolaryngology; pandemic; review.

Publication types

  • Review