Fungal osteomyelitis of the skull in patients after COVID-19 associated pneumonia.

Purpose. To demonstrate possibilities of multispiral computed tomography in the detection of fungal osteomyelitis in two patients with second type of diabetes mellitus two and six months after COVID-19 associated pneumonia. Material and methods. We present two clinical observations of patients with second type of diabetes mellitus who complained about pain in the upper jaw, nasal purulent discharge, difficulty in nasal breathing which appeared two and six months after COVID-19 associated pneumonia. To identify pathological changes, patients were directed to the department of radiology for the purpose of performing MSCT of the skull. Results. In the presented clinical cases, using MSCT, the features of the radiological semiotics of skull bone changes were studied in patients with fungal infection on the background of type 2 diabetes mellitus, the use of corticosteroids and after the viral COVID-19 associated pneumonia. The diagnosis was verified by histological and cytological studies of biopsy (surgical) material. Discussion. Recently, there has been an increase in the number of cases of fungal osteomyelitis of the jaws and paranasal sinuses in patients after viral pneumonia caused by SARS-CoV-2. The most common fungal infection is mucormycosis, caused by fungi belonging to the order Mucorales. The rhinocerebral form of mucormycosis is common in patients with diabetes mellitus after treatment with corticosteroids with the background of immunosuppression. This form of mucormycosis contributes to the appearance of extensive bone-destructive changes in the middle and upper zones of the maxillofacial region, requiring further surgical treatment. Conclusion. The 2019 coronavirus infection (COVID-19) caused by SARS-CoV-2 and type 2 diabetes remain urgent healthcare problems worldwide. This combination in a patient after treatment of COVID-19 associated pneumonia with corticosteroids leads to immunosuppression and the development of concomitant infections, including fungal ones. Fungal osteomyelitis in such patients, as a rule, affects the skull and is characterized by an aggressive course and requires surgical treatment. The use of modern and high-tech methods of radiation imaging, such as MSCT, allows to obtain complete diagnostic information about the localization and prevalence of the lesion, which, in the future, determines the management tactics and surgical treatment of patients of this category.Copyright © 2022 Chinese Journal of Pediatric Surgery. All rights reserved.

Fungal osteomyelitis of the skull in patients after COVID-19 associated pneumonia

Purpose. To demonstrate possibilities of multispiral computed tomography in the detection of fungal osteomyelitis in two patients with second type of diabetes mellitus two and six months after COVID-19 associated pneumonia. Material and methods. We present two clinical observations of patients with second type of diabetes mellitus who complained about pain in the upper jaw, nasal purulent discharge, difficulty in nasal breathing which appeared two and six months after COVID-19 associated pneumonia. To identify pathological changes, patients were directed to the department of radiology for the purpose of performing MSCT of the skull. Results. In the presented clinical cases, using MSCT, the features of the radiological semiotics of skull bone changes were studied in patients with fungal infection on the background of type 2 diabetes mellitus, the use of corticosteroids and after the viral COVID-19 associated pneumonia. The diagnosis was verified by histological and cytological studies of biopsy (surgical) material. Discussion. Recently, there has been an increase in the number of cases of fungal osteomyelitis of the jaws and paranasal sinuses in patients after viral pneumonia caused by SARS-CoV-2. The most common fungal infection is mucormycosis, caused by fungi belonging to the order Mucorales. The rhinocerebral form of mucormycosis is common in patients with diabetes mellitus after treatment with corticosteroids with the background of immunosuppression. This form of mucormycosis contributes to the appearance of extensive bone-destructive changes in the middle and upper zones of the maxillofacial region, requiring further surgical treatment. Conclusion. The 2019 coronavirus infection (COVID-19) caused by SARS-CoV-2 and type 2 diabetes remain urgent healthcare problems worldwide. This combination in a patient after treatment of COVID-19 associated pneumonia with corticosteroids leads to immunosuppression and the development of concomitant infections, including fungal ones. Fungal osteomyelitis in such patients, as a rule, affects the skull and is characterized by an aggressive course and requires surgical treatment. The use of modern and high-tech methods of radiation imaging, such as MSCT, allows to obtain complete diagnostic information about the localization and prevalence of the lesion, which, in the future, determines the management tactics and surgical treatment of patients of this category. © 2022 Chinese Journal of Pediatric Surgery. All rights reserved.

Atypical presentations of fungal osteomyelitis during post COVID-19 outbreak - Case series.

Introduction: Mucormycosis and Aspergillosis are opportunistic fungal infections causing significant morbidity and mortality. Post the outbreak of COVID-19, these fungal osteomyelitis have seen a global rise with few atypical presentations noted. Case report: Current case series reports three such atypical presentations of fungal osteomyelitis including mandibular fungal osteomyelitis in two patients, fungal osteomyelitis mimicking space infection in a middle aged male, and suspected mixed fungal osteomyelitis involving maxillary sinus. Aggressive surgical debridement was indicated along with institution of antifungal therapy (Liposomal Amphotericin B, and Posaconazole). The fungal osteomyelitis was successfully treated with surgical and medical management with no recurrence. Discussion: The injudicious use of corticosteroids in COVID-19 patients along with their immunocompromised status increases their susceptibility to opportunistic fungal osteomyelitis. Prompt and aggressive surgical intervention along with antifungal therapy is important after diagnosing fungal osteomyelitis, as a delay could increase the mortality rate considerably.

Covid-19-associated fungal osteomyelitis of jaws and sinuses: An experience-driven management protocol.

Invasive fungal co-infections with COVID-19 are currently being reported at an alarming rate. Our study explores the importance of early identification of the disease, probable etiopathogenesis, clinical and radiological features and a treatment protocol for COVID-19 Associated Fungal Osteomyelitis of Jaws and Sinuses (CAFOJS). A one-year prospective study from June 2020 to May 2021 was conducted among CAFOJS diagnosed patients at a tertiary care center in South India. Demographic details, COVID-19 infection and treatment history, time taken for initiation of symptoms after COVID-19 diagnosis, medical history and clinical features were recorded. All patients were managed with a standard diagnostic and intervention protocol which included pre-operative and post-operative administration of Inj. Amphotericin B 50 mg (liposomal), early aggressive surgical debridement and tab. Posaconazole GR 300 mg OD for 90 days after discharge. Thirty-nine (78%) patients were diagnosed with CAFOJS out of 50 osteomyelitis patients. 35 patients (90%) were diabetic and 21 patients (54%) were known to receive steroids during the COVID-19 treatment. Sole existence of Mucorales spp. was seen in 30 patients (77%), Aspergillus fumigatus in 2 patients (5%), Curvularia spp. in 2 patients (5%). Concomitant existence of Mucorales and Aspergillus fumigatus was reported in two patients (5%) and Candida albicans in three patients (8%). Patients underwent treatment with standard protocol and no recurrence noted. CAFOJS is a clinical entity with aggressive presentation and warrants early diagnosis and treatment. LAY SUMMARY: Invasive fungal infections of head and neck region cause necrosis of bones affected by it, especially maxilla. Early diagnosis and treatment are advocated in such infections due to its aggressive clinical presentation compared to similar infections before COVID-19 pandemic.

Mucormycotic osteomyelitis of maxilla post-COVID patient: a case report.

Fungal osteomyelitis is a life-threatening and seldom seen opportunistic infection. It is commonly an affectation of the nose and paranasal sinuses within the orofacial region. It is an aggressive infection that needs to be addressed promptly to prevent fatal consequences. The mode of infection is via the inhalation route and infection begins initially in the nose and paranasal sinuses with subsequent invasion into the vascular tissue, eventually leading to thrombosis and necrosis of nearby hard and soft tissues. Here, we report a case of a 31-year-old male who presented with pain over the upper jaw that was sudden in onset, continuous, dull aching, radiating towards forehead and neck of the left side, aggravates on mastication and relives on its own. He had a history of uncontrolled diabetes mellitus. On further investigation, using diagnostic and Interventional aids, a final diagnosis of mucormycotic osteomyelitis of the maxilla was made.

Mandibular mucormycosis following SARS-CoV-2 infection - A case report and review of literature.

BACKGROUND: The second wave of COVID-19 pandemic has seen an unprecedented rise in the number of mucormycosis cases worldwide and in India particularly. This otherwise rare fungal infection has become an endemic among patients who have recovered from recent SARS-CoV-2 infection. Among the different types of mucormycosis, rhino-orbital-cerebral involvement has mainly been observed in the recent surge of cases. Very few cases of mucormycosis of mandible have been reported in literature and none in COVID-19 patients. We report a case of isolated mandibular mucormycosis in a COVID- 19 patient, with no other predisposing comorbidities.Case report.A 39 year old patient recently recovered from COVID-19 presented with typical symptoms of osteomyelitis which was confirmed using computed tomography of face. He underwent thorough debridement and curettage and tissue was sent for culture, special staining and biopsy. RESULT: Diagnosis of mucormycosis was confirmed based on postoperative biopsy and special staining. He was further managed with complete course of appropriate antifungal therapy. CONCLUSION: Mucormycosis is a fulminant and aggressive infection which requires prompt diagnosis and intervention. Early referral to a maxillofacial surgeon by physicians and general dental practitioners on seeing signs and symptoms of secondary fungal infections involving maxilla or mandible in patients with history of SARS-CoV-19 infection can improve prognosis.