Revised workflow practices in the management of acute invasive fungal sinusitis during the COVID-19 pandemic

Objective: To document changes in evaluation protocols for acute invasive fungal sinusitis (AIFS) during the COVID-19 pandemic and to analyse concordance between clinical and histopathological diagnosis based on new practice guidelines. Methods: Protocols for patient evaluation with suspected AIFS both prior and during the COVID-19 period are described. Retrospective analysis of patients with suspected AIFS from May 1st to June 30th 2021 and the concordance between clinical and final diagnosis was done. Results: Among 171 patients with high clinical suspicion, 160 (93.6%) correlated with the final histopathological diagnosis of invasive fungal sinusitis, providing a 100% sensitivity, positive predictive value of 93.6% and a negative predictive value of 100%. Conclusion: Our study highlights a valuable screening tool with good accuracy involving emphasis on red flag signs in high-risk populations. This could be valuable in situations demanding avoidance of aerosol generating procedures and in resource limited settings facilitating early referral to higher centres.