Non Mucor Fungal Invasive Rhino Sinusitis with Ocular Signs in SARS Cov-2 Infection with Delta Variant (B.1.617.2) in India.

Abstract Objective: To highlight fungi other than mucoromycetes as causative agent of invasive rhinosinusitis with ocular signs in recovered or concurrent covid 19 patients and identifying the presenting features, risk factors, intervention and outcomes.Method and analysis- Retrospective interventional study of seven patients with covid 19 who developed non mucor invasive rhinosinusitis with ocular involvement. Clinical presentation ,history and investigations analyzed. Management was by intravenous liposomal amphotericin B and functional endoscopic sinus surgery (FESS) with paranasal sinus debridement. Limited orbital debridement with or without transcutaneous retrobulbar liposomal amphotericin B(TRAMB) was done in patients with orbit involvement. Postoperative antifungal therapy was decided on basis of the causative fungi. Results- Four cases of Aspergillus and one each of Fusarium, Culvularia and Penicillium was seen .All patients had prominent periocular swelling and edema with pain and nasal stuffiness. Orbit involvement on MRI was seen in four cases: Partial third nerve palsy was seen in two and cavernous sinus thrombosis was seen in one with aspergillosis. Proptosis was not witnessed in any case. History of Diabetes and use of steroids was seen in all. All patients had mild to moderate covid with oxygen supplementation needed in one. No mortality , vision loss or exenteration happened. Conclusion: Secondary infection by Fungi other than mucoromycetes can be seen in covid 19. Timely surgical intervention and use of appropriate antifungals by correctly identifying causative fungi can lead to good prognosis.