ABSTRACT
Coronavirus disease 2019 (COVID-19) is a pandemic disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-COV-2). COVID-19 infections may be associated with a wide range of bacterial and fungal co-infections. Recent studies are reporting invasive fungal infection associated with severe COVID-19. Herein, we report a case of COVID-19 rhino-orbital mucormycosis infection caused by Rhizopus sps in a 32 year old diabetic patient who was successfully managed with early aggressive debridement of infected tissue endoscopically with extended ethmoidectomy by modified Denker's approach along with orbital decompression and antifungal therapy with Liposomal Amphotericin B and Posaconazole. Serial diagnostic nasal endoscopy showed no evidence of progression of the infection. The patient was discharged on 21st day of hospitalization still on oral Posaconazole for a total of 3 months. Copyright © 2022, Kathmandu University. All rights reserved.
ABSTRACT
Rationale and Objectives-At present, sinonasal mucormycosis is most worrisome COVID-19 related complication in India while western countries have relatively stayed aloof. But given the pervasive nature of fungi and presence of all predisposing conditions even in western countries, it is imperative to have knowledge about the imaging patterns and staging of the disease. In this study, we try to single out factors responsible for the sudden increment in the incidence of sinonasal mucormycosis among covid-19 patients and discuss their imaging features. Patients and Methods-The case records of 30 patients, between January to May, 2021, with positive RT-PCR for COVID-19 and biopsy proven sinonasal mucormycosis were retrospectively evaluated. Results – Out of 30 patients, 28 had raised random blood glucose level and 24 had raised ferritin level. On imaging, nasal cavity involvement was seen in 18 patients. Paranasal sinuses were involved in 28 patients. The disease process also showed involvement of orbit, neck spaces and intracranial extension. We divided sinonasal mucormycosis into four groups and mortality was seen in patients of stage 3 and 4 (total mortality was 26.7%). Conclusion-MRI played an important role in diagnosis and staging of sinonasal mucormycosis as well as determining the extrasinus extent of disease. Mortality was seen in patients presenting in advanced stage of the disease, with orbital or intracranial extension. Thus, it is imperative that high index of suspicion, early imaging with diagnosis and aggressive management protocol needed to reduce morbidity and mortality.
ABSTRACT
Iron overload occurs as a result of multiple blood transfusions and increased iron absorption in thalassemia patients. Iron deposition in liver results in liver stiffness and fibrosis. Non invasive methods including imaging and serum biomarkers have been introduced for assessment of liver fibrosis. We aimed to study liver stiffness using transient elastography and serum hyaluronic acid levels and correlate them with serum ferritin levels in adult transfusion dependent beta thalassemia patients. MATERIAL: 70 transfusion dependent thalassemia patients of age ≥18 years, registered at Thalassemia Day Care Centre were subjected to investigations like CBC, Liver function tests, viral markers, serum ferritin, serum hyaluronic acid levels and transient elastography. Fibrosis indices like FIB-4, AAR and APRI were also calculated. 45 patients had T2*MRI reports with them;which were also included and analysed. Spearman coefficient r was used to test correlations between TE values and serum HA levels with other variables. OBSERVATION: 70 patients (41 male and 29 female) with mean age of 24.09±5.38 years and BMI 20.51 ±3.47 kg/m², were enrolled. Median values of hemoglobin, AST, ALT, TE, serum HA and serum ferritin were, 9.15 g/dl, 42 IU/L, 47.50 IU/L, 9.1 kPa, 284 ng/dl and 1841 ng/ml, respectively . TE values had significant positive correlation with serum ferritin (r=0.5, p < 0.001), ALT (r=0.59, p < 0.001), AST (r=0.58, p< 0.001), APRI (r=0.5, p<0.001) and FIB-4 (p=0.02), respectively and significant negative correlation with T2* MRI (ms) (r= -0.5, p<0.001). No significant correlation of HA was found with any variable. CONCLUSION: Transient elastography can be used as a non expensive, easily accessible and non invasive marker of liver iron overload. Further detailed studies are required to establish the role of serum Hyaluronic acid in thalassemia patients. © Journal of the Association of Physicians of India 2011.