Histopathological Examination in the Categorization of fungal Rhinosinusitis - a Retrospective Study

Introduction: Fungal Rhinosinusitis is broadly defined as any sinonasal pathology related to the presence of fungi and is increasingly recognized worldwide. This study aimed to assess and ascertain the need for histopathological examination in the management of fungal Rhinosinusitis. Materials and Methods: This study was performed over two years, from April 2019 to April 2021, in the Department of Pathology, Vinayaka Missions KirupanandaVariyar Medical College and Hospital, Salem. A total of 383 cases of rhinosinusitis/nasal polyps were studied. Histopathological examination and categorization were done and compared with clinical diagnosis. Results: Only 4/18 cases of acute fungal Rhinosinusitis were correctly diagnosed(22.22%). Nineteen cases of the fungal ball were diagnosed, but none was correctly categorized. Clinical suspicion of fungal sinusitis was present in 10 cases of Rhinosinusitis, which turned out to be chronic Rhinosinusitis in histopathology. In AFRS, fungal elements were overlooked in Hematoxylin and Eosin stained slides and identified only by Grocottmethenamine silver in one-fourth of the cases. Conclusions: Though clinical diagnosis was made in 86% of fungal rhinosinusitis cases, correct categorization was done only in one-third of cases. CT scan could diagnose 60% of cases, but none was categorized. As treatment depends on the type of fungal Rhinosinusitis, histopathological examination is the gold standard for diagnosing and treating fungal Rhinosinusitis.

Utilizing CT soft-tissue markers as a screening tool for acute invasive fungal sinusitis

Objectives: Acute invasive fungal sinusitis (AIFS) is a rapidly progressive disease, whose delayed identification results in poor outcomes, especially in immunocompromised individuals. A surge in of AIFS in the wake of the COVID-19 pandemic, has lent additional morbidity and mortality to an already precarious clinical scenario. Early detection of AIFS in individuals who are symptomatic/ at risk can allow early therapy, enabling better patient outcomes. Our study aims to determine optimal soft-tissue markers on CT for the early detection of AIFS. Methods: In this case-control study, 142 patients with equal distribution of subjects were chosen based on histopathological diagnosis of AIFS; and their non-contrast CT scans were retrospectively assessed to determine the diagnostic utility of specific soft-tissue markers that would enable diagnosis of AIFS. Results: A total of 9 markers with adequate sensitivity and specificity were identified, including pterygopalatine and sphenopalatine fossae, inferior orbital fissure and nasolacrimal duct involvement, premaxillary thickening, retro-antral and orbital stranding, and infratemporal muscle edema. It was determined that the combined occurrence of any 3 out of 9 markers was 91.5% sensitive and 95.9% specific for diagnosis of AIFS (p < 0.005). Conclusion: Early, accurate detection of AIFS in predisposed individuals is possible with identification of soft-tissue markers on NECT, enabling early intervention. Advances in knowledge: Being the aggressive disease that it is, AIFS may be managed early if the index of suspicion is held high via CT imaging; which our diagnostic checklist aims at enabling.

Molecular Diagnosis of Fungal Sinusitis Using Limit of Detection

Background: As an inflammatory process that involves the paranasal sinuses, chronic sinusitis (CS) is one of the most prevalent chronic illnesses that affects all age groups. Parasitic fungi are involved in sinusitis infections. Objective: This study is aimed at the molecular detection of sinusitis caused by such fungi. Methods: Seventy-two samples were collected from the secretions of maxillary and frontal sinuses of patients from Rasoul-e Akram (PbUH) Hospital in Tehran during sinus operation. Fungal genomic DNA was extracted by a DNP kit. The detection of fungi was carried out by employing a sequence-specific target, namely mt cyte b gene locus, and using primers. Polymerase chain reaction (PCR) was optimized, and the limit of detection (LOD) and specificity tests were performed. The amplicon was cloned by the T/A cloning method, which was used for sequencing and positive control. Results: The 430-bp PCR product underwent appropriate propagation before being amplified and was observed on 1.5% electrophoreses gel. The evaluation of the selected primers with seven DNA constructs from another microorganisms demonstrated 100% specificity. The limit of detection of the optimized test was evaluated up to 50 fungi. Out of 72 samples, 9.7% were positive for fungi existence. Conclusions: This study indicated that molecular diagnosis of the target mt cyte b gene using LOD enhances clinical laboratory detection of fungal sinusitis.

Bilateral maxillectomy via mid-facial degloving approach in an extensive case of post-Coronavirus disease invasive fungal sinusitis

<p class="abstract">Coronavirus disease associated invasive fungal sinusitis has affected many and several have succumbed to the disease during the second wave of COVID-19 pandemic. Mucormycosis is a rare, opportunistic, fulminant, angioinvasive fungal infection caused by Rhizopus species of the order Mucorales. It mainly affects immunocompromised individuals, predisposed by diabetes mellitus, corticosteroids, immunosuppressive therapy, haematological malignancies and organ transplantation. We reported here a case of a 45 years old male with past history of Coronavirus disease, presenting with symptoms of invasive fungal sinusitis. With this case we emphasised on use of an alternate approach for bilateral total maxillectomy via midfacial degloving approach instead of a classical external Weber Ferguesen incision in extensive cases with several associated co-morbidities. Mid facial degloving approach is a combination of intraoral and intranasal incisions made to access the midface without any external incision. This approach is advantageous in comparatively having less complication rate, less morbidity and excellent cosmetic outcome.</p>

346. Head to Toe Imaging of Complications and Sequelae of COVID- 19 and COVID-19 Vaccination

Background COVID 19 is associated with a hypercoagulable state with cytokine storm syndrome and thrombocytopenia leading to complications across various systems. COVID-19 infection, its treatment, resultant immunosuppression, and pre-existing comorbidities have made patients vulnerable to secondary infections Methods We systematically reviewed COVID-19 cases between Jan to May 2021 for pulmonary and extrapulmonary complications. Patients with recent COVID-19 vaccination and neurological symptoms were also included. Figure 1. “Black turbinate” sign of mucormycosis Contrast enhanced coronal T1 FS images of paranasal sinuses shows necrotic non-enhancing right superior and middle turbinates (*) with extension into the right orbital fat. FIGURE 2 - A composite image of Coronal CT of upper abdomen in arterial phase and lung bases in lung window showing wedge showing right renal infarcts (line arrow) due to inferior polar artery thrombosis and ground glass opacities (solid arrow) in lung bases. Results Neurological complications: Neurological complications include ischemic and haemorrhagic strokes. Other complications are encephalopathy, encephalitis, Guillain-Barré syndrome, acute hemorrhagic necrotizing encephalopathy. Demyelination and radiculopathies are seen as post vaccination complications. Mucormycosis: Unprecedented high rate of invasive fungal sinusitis in association with COVID -19 is reported from the Indian subcontinent. This has a propensity for intra orbital and intracranial extension. COVID -19 associated coagulopathy: COVID -19 is a pro-inflammatory hypercoagulable state. Pulmonary thromboembolism, deep venous thrombosis and catheter related thrombosis are well documented. Cardiac complications: Cardiac manifestations include Myocardial Injury with non-obstructed coronary arteries (MINOCA), myocarditis, myocardial ischemia, cardiomyopathy. Pulmonary complications and sequelae of COVID -19: Progression of lung injury to ARDS during the initial phase and fibrosis of parenchyma in the recovery phase. Spontaneous pneumomediastinum, pneumatoceles and pneumothorax and secondary infections are identified in our study. COVID- 19 associated gastrointestinal complications: Patients evaluated for renal colic, pancreatitis, cholecystitis showed, ground glass opacities or subpleural bands in typical Covid-19 distribution. COVID-19 may lead of acute kidney and bowel injury due to arterial thrombosis. COVID - 19 associated myonecrosis: Ischemia of the small caliber vessels may result in myonecrosis. FIGURE 3 - Coronal STIR image shows thickened and hyperintense trunks and divisions of the right brachial plexus suggestive of plexopathy in a COVID -19 patient with H/O recent COVID-19 vaccination. Figure 4. Axial CT chest section in lung window showing pneumothorax (white arrow) and pneumatocele ( grey arrow) with peripheral ground glass opacities and consolidations in both lungs. Conclusion Awareness of these unusual manifestations will facilitate an early diagnosis, improve management and help reduce morbidity and mortality Disclosures All Authors: No reported disclosures