Fungal Rhinosinusitis: A Clinicopathological, Microbiological, And Radiological Correlation

Abstract

Background: Fungal rhinosinusitis (FRS) ranges from non-invasive to invasive life-threatening forms. Accurate diagnosis requires integrated clinical, radiological, microbiological, and histopathological evaluation. With the rise of invasive forms in the post-COVID era, early recognition is critical for better outcomes.

Objectives: To correlate clinical, radiological, microbiological, and histopathological findings in patients with fungal rhinosinusitis and analyze their association with risk factors.

Methods: This observational cross-sectional study was conducted over 18 months at a tertiary care center in Mumbai and included 100 patients. Clinical evaluation, CT imaging, KOH mount, fungal cultures, and histopathology were performed. Data were analyzed using chi-square and t-tests with p < 0.05 considered significant.

Results: The mean age was 45.2 years, with near-equal gender distribution. Nasal obstruction (71%) and headache (54%) were the commonest symptoms. Uncontrolled diabetes (58%) and prior COVID-19 (29%) were major risk factors, strongly linked with invasive disease. The maxillary sinus (80%) was most frequently involved, with bone erosion in 46%. Acute invasive FRS (57%) predominated. Mucor (44%) was the leading isolate, while histopathology confirmed disease in 75% of cases.

Conclusion: FRS in the post-COVID era is characterized by a predominance of invasive forms, mainly due to Mucor, with uncontrolled diabetes and COVID-related immunological compromise as key risk factors. Maxillary sinus involvement and frequent bone erosion highlight its aggressive course. Early multidisciplinary diagnosis remains vital to improve outcomes.