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2.
Neurol India ; 70(3): 1052-1056, 2022.
Article in English | MEDLINE | ID: covidwho-1934349

ABSTRACT

Context: During the challenging second wave of the COVID-19 pandemic, we encountered a most dreadful fungal infection in the form of COVID-associated mucormycosis (CAM), with a varied pattern of presentation from previous experience. Patients presented with simple fungal sinusitis or more complicated brain abscesses, and newer manifestations such as skull osteomyelitis. We report our findings and innovative treatment strategies used to manage this morbid condition. Objectives: To study the various presentations and surgical strategies in treating post-COVID rhino-orbito-cerebral mucormycosis (ROCM). Settings and Design: Observational cross-sectional study. Methods and Materials: From May to October 2021, 270 patients with CAM were admitted to Andhra Medical College Department of Neurosurgery, King George Hospital, Visakhapatnam, India. A cohort of 61 cases with intracranial involvement was studied in detail. The varied presentations and different or innovative treatment modalities were analyzed. Results: The death rate was 30/270 in the whole cohort, and three deaths (4.9%) occurred in 61 cases with cranial involvement. Thirty-three (54.1%) of the 61 cases were treated surgically: 17 patients required bone excision (for focal osteomyelitis) and 16 cases required abscess drainage/excision. Conclusions: Post-COVID mucormycosis (especially with intracranial involvement) is a highly challenging entity. A multidisciplinary approach with early and aggressive anti-fungal medication combined with timely surgical interventions offers some hope of overcoming this complex infection in CAM patients. We identified some novel techniques during regular follow-up that have proven helpful in combatting this devastating condition.


Subject(s)
COVID-19 , Mucormycosis , Osteomyelitis , Antifungal Agents/therapeutic use , Cross-Sectional Studies , Debridement/methods , Humans , Mucormycosis/epidemiology , Mucormycosis/surgery , Osteomyelitis/drug therapy , Pandemics
3.
BMJ Case Rep ; 15(5)2022 May 31.
Article in English | MEDLINE | ID: covidwho-1874523

ABSTRACT

Zygomatic osteomyelitis is a rare occurrence due to rich collateral blood supply of bone. A man in his 30s presented with complaints of pain over bilateral cheek and pus discharge below the eye on lateral aspect. He was a known case of COVID-19 associated mucormycosis postendoscopic debridement of sinuses 3 months back. Radiology revealed bilateral destruction of zygoma with discharging sinus. Microbiological analysis confirmed aseptate hyphae in pus, and a diagnosis of bilateral fungal zygomatic osteomyelitis made. Under general anaesthesia, sequestrectomy done using bilateral lateral rhinotomy with extended Dieffenbach's approach (batwing incision). Postsurgery 3000 mg of liposomal amphotericin was administered. There was no enophthalmos or restricted eye movements postoperatively. Follow-up MRI suggested minimal inflammatory enhancement in maxillary sinus. Patient was discharged on oral antifungals.


Subject(s)
COVID-19 , Mucormycosis , Osteomyelitis , Surgical Wound , Humans , Male , Mucormycosis/diagnosis , Mucormycosis/surgery , Osteomyelitis/diagnostic imaging , Osteomyelitis/microbiology , Osteomyelitis/surgery , Suppuration , Zygoma/surgery
5.
Acta Medica (Hradec Kralove) ; 64(4): 218-223, 2021.
Article in English | MEDLINE | ID: covidwho-1743011

ABSTRACT

BACKGROUND: The second wave of COVID-19 has emerged with the addition of vivid types of oral manifestations. Immunosuppression caused by COVID-19 results in an exacerbation of pre-existing infections. Recently, in the backdrop of COVID-19 expression, a notable rise in the incidence of secondary infections, both fungal and bacterial, have been reported either during the disease or as a post-COVID manifestation. CASE PRESENTATION: A 70-year-old male diabetic COVID-19 patient reported with a chief complaint of pain in the right side maxillary region for 3 months and the passage of content from the oral cavity into the nose. Intraoral examination revealed missing teeth i.r.t. 12 to 17, denuded mucosa with exposed necrotic bone and an oroantral opening. Sequestrectomy was done and the tissue was sent for histopathological examination which revealed necrotic bone interspersed with broad aseptate fungal hyphae branched at right angles along with actinomycotic colonies and Candidal hyphae in few areas. Based on histopathological findings, a final diagnosis of mixed infections leading to Maxillary Osteomyelitis was given. No recurrence was noticed after 3 months of follow up. CONCLUSIONS: The occurrence of oral infections even after the remission period of COVID-19 signifies an alarming sign both for the patient and clinicians monitoring the oral health status during the follow-up period. To our knowledge, this is the first such case (three oral infections as a post covid manifestation in a single diabetic patient) reported in the literature till date.


Subject(s)
Actinomycosis , COVID-19 , Candidiasis , Coinfection , Diabetes Mellitus , Mucormycosis , Osteomyelitis , Aged , COVID-19/complications , Candidiasis/complications , Coinfection/complications , Humans , Male , Mucormycosis/complications , Osteomyelitis/microbiology , SARS-CoV-2
6.
JBJS Case Connect ; 12(1)2022 02 24.
Article in English | MEDLINE | ID: covidwho-1705410

ABSTRACT

CASE: We report the case of a coronavirus disease 2019 (COVID-19)-recovered, 42-year-old man with osteonecrosis and concomitant acute bacterial osteomyelitis of both hips and his left knee. The patient underwent total hip replacement for both hips and arthroscopic decompression and synovectomy of the knee joint. On follow-up, he has complete and painless range of motion with resolving osteomyelitis and no signs of active infection. CONCLUSION: Corticosteroid therapy and COVID-19-associated thrombotic microangiopathy might have caused osteonecrosis in our patient. However, concomitant osteomyelitis is extremely rare and might be overlooked because of elevated inflammatory markers after recovery from COVID-19 infection.


Subject(s)
COVID-19 , Osteomyelitis , Osteonecrosis , Adult , COVID-19/complications , Humans , Knee Joint/surgery , Male , Osteomyelitis/complications , SARS-CoV-2
7.
Med Mycol ; 60(2)2022 Feb 02.
Article in English | MEDLINE | ID: covidwho-1648766

ABSTRACT

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.


Subject(s)
COVID-19 , Osteomyelitis , Antifungal Agents/therapeutic use , COVID-19/diagnosis , COVID-19/drug therapy , COVID-19/epidemiology , COVID-19 Testing , Comorbidity , Humans , Jaw , Osteomyelitis/diagnosis , Osteomyelitis/drug therapy , Osteomyelitis/epidemiology , Pandemics , Prospective Studies , SARS-CoV-2
8.
Pan Afr Med J ; 39: 275, 2021.
Article in English | MEDLINE | ID: covidwho-1485483

ABSTRACT

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.


Subject(s)
COVID-19/complications , Maxillary Diseases/diagnosis , Mucormycosis/diagnosis , Osteomyelitis/diagnosis , Adult , Diabetes Mellitus/physiopathology , Humans , Male , Maxillary Diseases/microbiology , Maxillary Diseases/pathology , Mucormycosis/pathology , Opportunistic Infections/diagnosis , Opportunistic Infections/microbiology , Opportunistic Infections/pathology , Osteomyelitis/microbiology , Osteomyelitis/pathology
11.
BMJ Case Rep ; 14(9)2021 Sep 16.
Article in English | MEDLINE | ID: covidwho-1416638

ABSTRACT

Mucormycosis is a very commonly encountered disease in the sinonasal region in patients with diabetes and immunocompromised status specially in the northern part of the Indian continent. Due to its fulminant nature and involvement in the rhino-orbital-cerebral region, prognosis is poor even after extensive debridement and amphotericin-B therapy. We present a case with diagnosis of sarcoidosis being treated with systemic steroids who developed sudden-onset ptosis and left lateral rectus palsy. On radiological evaluation with MRI, a heterogenously peripherally enhancing lesion was seen in the nasopharynx suggestive of nasopharyngeal abscess. The patient was taken up for emergency surgery; a necrotic lesion with destruction of sphenoid bone, pterygoids and clivus was seen originating in the nasopharynx. The lesion on fungal staining came out to be broad aseptate hyphae suggestive of mucormycosis.


Subject(s)
Mucorales , Mucormycosis , Osteomyelitis , Antifungal Agents/therapeutic use , Debridement , Humans , Mucormycosis/diagnosis , Mucormycosis/drug therapy , Osteomyelitis/diagnostic imaging , Osteomyelitis/drug therapy , Skull Base/diagnostic imaging
12.
Br J Community Nurs ; 26(Sup6): S6-S9, 2021 Jun 01.
Article in English | MEDLINE | ID: covidwho-1262692

ABSTRACT

Community nurses face numerous challenges in both diagnosing and effectively treating their patients. The diabetic patient has complex needs requiring a holistic approach. With a reported increase in diabetic patients, and a possible decline in some routine screening following Covid-19 pandemic, complications in diabetic patients are likely to rise. It is estimated that 25% of diabetic patients will develop a diabetic foot ulcer (DFU), with a reported 43% of DFU already infected at first presentation to a health professional. NICE categorise the level of infection in DFU based on standardised assessments such as SINBAD. A high categorised DFU has the possibility of osteomyelitis. It is imperative that osteomyelitis is treated immediately to achieve positive outcomes, benefitting the patients' health and wellbeing in addition to reducing the financial implications to the NHS.


Subject(s)
COVID-19 , Community Health Nursing/standards , Diabetic Foot/nursing , Holistic Nursing/standards , Nurse's Role , Osteomyelitis/nursing , Practice Guidelines as Topic , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Pandemics , SARS-CoV-2
13.
Khirurgiia (Mosk) ; (4): 53-57, 2021.
Article in Russian | MEDLINE | ID: covidwho-1148387

ABSTRACT

The incidence of mediastinitis after median sternotomy makes up 1-3%. This complication results prolonged hospital-stay, significant increase in treatment cost and high mortality (up to 75%). Severe COVID-19 pneumonia is often manifested by coughing, that impairs sternum stability after osteosynthesis. Moreover, concomitant leukopenia increases the risk of mediastinitis. Viral pneumonia and mediastinitis are complicated by respiratory failure and mutually potentiate the negative effect. Negative pressure wound therapy (NPWT) with combined antibiotic therapy ensures a favorable outcome even in patients with postoperative mediastinitis and osteomyelitis combined with viral pneumonia.


Subject(s)
Anti-Bacterial Agents/therapeutic use , COVID-19/complications , Mediastinitis/therapy , Negative-Pressure Wound Therapy/methods , Osteomyelitis/therapy , Sternotomy/adverse effects , Sternum/surgery , Surgical Wound Infection/therapy , COVID-19/diagnosis , Humans , Mediastinitis/diagnosis , Osteomyelitis/diagnosis , Osteomyelitis/etiology , Postoperative Complications , SARS-CoV-2 , Surgical Wound Infection/diagnosis , Treatment Outcome
15.
J Craniofac Surg ; 32(5): 1803-1804, 2021.
Article in English | MEDLINE | ID: covidwho-1060972

ABSTRACT

ABSTRACT: Skull base osteomyelitis that is secondary to otitis media is extremely rare in the modern antibiotic era. The authors present an 84-year-old male with atypical skull base osteomyelitis that developed from otitis media during the COVID-19 pandemic due to delayed diagnosis and partial treatment which is blamed for development of skull base osteomyelitis. The atypical presentations of skull base osteomyelitis pose a diagnostic challenge. This case highlights that even otitis media is a potentially fatal infection in older patients with diabetes. Early diagnosis and aggressive management of skull base osteomyelitis are of upmost importance and will ensure a more favorable prognosis.


Subject(s)
COVID-19 , Osteomyelitis , Otitis Media , Aged , Aged, 80 and over , Delayed Diagnosis , Humans , Male , Osteomyelitis/diagnosis , Osteomyelitis/etiology , Otitis Media/complications , Otitis Media/diagnosis , Pandemics , SARS-CoV-2 , Skull Base/diagnostic imaging
16.
Br J Community Nurs ; 25(8): 376-380, 2020 Aug 02.
Article in English | MEDLINE | ID: covidwho-708758

ABSTRACT

There has been a surging interest in using elastomeric infusion devices to deliver outpatient parenteral antimicrobial therapy (OPAT), which is more cost-effective than standard antibiotic administration, which requires multiple daily home visits. This has been particularly important since the outbreak of the coronavirus pandemic, because reducing patient contact can also help to minimise transmission of COVID-19 to outpatients who are at a high risk of COVID-19-triggered complications. In this retrospective study, the clinical effectiveness of intravenous (IV) infusion of flucloxacillin using an elastomeric device was explored in a convenience sample of patients. Patients with three primary infective diagnoses-bloodstream infection, non-vertebral osteomyelitis and vertebral osteomyelitis-were included in the analyses. In non-vertebral osteomyelitis patients, Accufuser antibiotic infusion shortened the course of OPAT care relative to standard antibiotic administration (p<.05). In contrast, in vertebral osteomyelitis patients, it prolonged the course of OPAT care relative to standard administration (p<.05). In patients with bloodstream infections, no significant difference was found between the treatment modes (p=.93). Thus, the clinical effectiveness of Accufuser antibiotic infusion varies among patients with different infective diagnoses, and there seems to be a complex relationship between the method of antibiotic delivery and the patient's condition.


Subject(s)
Anti-Bacterial Agents/administration & dosage , Bacteremia/drug therapy , Community Health Nursing/methods , Floxacillin/administration & dosage , Home Infusion Therapy/methods , Infusion Pumps , Osteomyelitis/drug therapy , Spinal Diseases/drug therapy , Betacoronavirus , COVID-19 , Coronavirus Infections/prevention & control , Delivery of Health Care/methods , Elastomers , Humans , Infusions, Intravenous/instrumentation , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Retrospective Studies , SARS-CoV-2
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