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1.
J Allergy Clin Immunol Pract ; 10(6): 1423-1432, 2022 06.
Article in English | MEDLINE | ID: covidwho-1747846

ABSTRACT

The COVID-19 pandemic has raised awareness about olfactory dysfunction, although a loss of smell was present in the general population before COVID-19. Chronic rhinosinusitis (CRS) is a common upper airway chronic inflammatory disease that is also one of the most common causes of olfactory dysfunction. It can be classified into different phenotypes (ie, with and without nasal polyps) and endotypes (ie, type 2 and non-type 2 inflammation). However, scientific information regarding CRS within the context of COVID-19 is still scarce. This review focuses on (1) the potential effects of severe acute respiratory syndrome coronavirus 2 infection on CRS symptoms, including a loss of smell, and comorbidities; (2) the pathophysiologic mechanisms involved in the olfactory dysfunction; (3) CRS diagnosis in the context of COVID-19, including telemedicine; (4) the protective hypothesis of CRS in COVID-19; and (5) the efficacy and safety of therapeutic options for CRS within the context of COVID-19.


Subject(s)
COVID-19 , Nasal Polyps , Olfaction Disorders , Rhinitis , Sinusitis , Anosmia , Chronic Disease , Humans , Nasal Polyps/complications , Nasal Polyps/epidemiology , Nasal Polyps/therapy , Olfaction Disorders/epidemiology , Pandemics , Rhinitis/epidemiology , Rhinitis/etiology , Rhinitis/therapy , Sinusitis/epidemiology , Sinusitis/etiology , Sinusitis/therapy
2.
Diabetes Metab Syndr ; 15(5): 102267, 2021.
Article in English | MEDLINE | ID: covidwho-1377695

ABSTRACT

AIMS: 1: Describe the epidemiology and determine risk factors for COVID-19 associated mucormycosis. 2: Elaborate the clinical spectrum of Rhino-Orbital-Cerebral Mucormycosis (ROCM), pattern of neuroaxis involvement and it's radiological correlates. METHODS: Observational study. Consecutive, confirmed cases of mucormycosis (N = 55) were included. A case of mucormycosis was defined as one who had clinical and radiological features consistent with mucormycosis along with demonstration of the fungus in tissue via KOH mount/culture/histopathological examination (HPE). Data pertaining to epidemiology, risk factors, clinico-radiological features were analysed using percentage of total cases. RESULTS: Middle aged, diabetic males with recent COVID-19 infection were most affected. New onset upper jaw toothache was a striking observation in several cases. Among neurological manifestations headache, proptosis, vision loss, extraocular movement restriction; cavernous sinus, meningeal and parenchymal involvement were common. Stroke in ROCM followed a definitive pattern with watershed infarction. CONCLUSIONS: New onset upper jaw toothache and loosening of teeth should prompt an immediate search for mucormycosis in backdrop of diabetic patients with recent COVID-19 disease, aiding earlier diagnosis and treatment initiation. Neuroaxis involvement was characterized by a multitude of features pertaining to involvement of optic nerve, extraocular muscles, meninges, brain parenchyma and internal carotid artery.


Subject(s)
COVID-19/complications , Mucormycosis/epidemiology , Mucormycosis/etiology , Adult , COVID-19/epidemiology , Central Nervous System Fungal Infections/epidemiology , Central Nervous System Fungal Infections/etiology , Eye Infections, Fungal/epidemiology , Eye Infections, Fungal/etiology , Female , Humans , India/epidemiology , Male , Middle Aged , Nervous System Diseases/epidemiology , Nervous System Diseases/etiology , Nervous System Diseases/microbiology , Orbit/microbiology , Orbital Diseases/epidemiology , Orbital Diseases/microbiology , Prevalence , Rhinitis/epidemiology , Rhinitis/etiology , Rhinitis/microbiology , Risk Factors , SARS-CoV-2/physiology , Socioeconomic Factors
3.
Am J Trop Med Hyg ; 105(2): 449-453, 2021 Jul 08.
Article in English | MEDLINE | ID: covidwho-1371040

ABSTRACT

COVID-19 first emerged in Wuhan, China, in December 2019. Since that time, the frequency of bacterial and fungal coinfections has been continuously increasing. Although invasive pulmonary aspergillosis is being increasingly recognized in association with COVID-19, there is limited information regarding COVID-19-associated mucormycosis. We describe a 50-year-old woman with uncontrolled diabetes who received systemic corticosteroids and remdesevir during her admission for COVID-19. A few days after discharge, the patient was readmitted because of facial swelling and numbness, and a diagnosis of COVID-19-associated rhinosinusitis mucormycosis caused by Rhizopus arrhizus (formerly called Rhizopus oryzae) was confirmed with sequencing of the internal transcribed spacer region of the ribosomal DNA. This report aimed to address the importance of short-term follow-up for COVID-19 patients who have received systemic corticosteroids, particularly those with predisposing conditions, because early detection and prompt, aggressive treatment are essential for the management of invasive fungal infections.


Subject(s)
Adrenal Cortex Hormones/therapeutic use , COVID-19/complications , COVID-19/drug therapy , Rhinitis/etiology , Rhizopus oryzae/pathogenicity , SARS-CoV-2/drug effects , Sinusitis/etiology , Adrenal Cortex Hormones/administration & dosage , Adrenal Cortex Hormones/adverse effects , DNA, Fungal/genetics , DNA, Ribosomal Spacer/genetics , Diabetes Mellitus , Fatal Outcome , Female , Humans , Invasive Fungal Infections/etiology , Middle Aged , Mucormycosis , Rhinitis/diagnosis , Rhinitis/microbiology , Sinusitis/diagnosis , Sinusitis/microbiology
5.
J Med Virol ; 93(4): 2499-2504, 2021 04.
Article in English | MEDLINE | ID: covidwho-1217398

ABSTRACT

Various new clinical signs and symptoms, such as dysfunction of smell (anosmia) and taste (dysgeusia) have emerged ever since the coronavirus disease 2019 (COVID-19) pandemic begun. The objective of this study was to identify the clinical presentation and factors associated with 'new loss/change of smell (anosmia) or taste (dysgeusia)' at admission in patients positive by real time polymerase chain reaction for SARS-CoV-2 infection. All adult COVID-19 patients with new onset anosmia or dysgeusia at admission were included in study group. Equal number of age and gender matched COVID-19 patients without anosmia or dysgeusia at admission were included in the control group. A total of 261 COVID-19 patients were admitted during the study period of which 55 (21%) had anosmia and or dysgeusia. The mean (SD) age was 36 (13) years and majority were males (58%, n = 32). Comorbidity was present in 38% of cases (n = 21). Anosmia and dysgeusia were noted in more than 1/5th of the cases. Anosmia (96%, n = 53) was more common than dysgeusia (75%, n = 41). Presence of both ansomia and dysgeusia was noted in 71% of patients (n = 39). On comparing the cases with the controls, on univariate analysis, fever (higher in cases), rhinitis (lower in cases), thrombocytopenia, elevated creatinine and bilirubin (all higher in cases) were significantly associated with anosmia or dysgeusia. On multivariate analysis, only rhinitis (odds ratio [OR]: 0.28; 95% confidence interval [CI]: 0.09-0.83; p = .02) thrombocytopenia (OR: 0.99; 95% CI: 0.99-0.99; p = .01) and elevated creatinine (OR: 7.6; 95% CI: 1.5-37.6; p = .01) remained significant. In this retrospective study of COVID-19 patients, we found anosmia and dysgeusia in more than 1/5th of the cases. Absence of rhinitis, low platelet counts and elevated creatinine were associated with anosmia or dysgeusia in these patients.


Subject(s)
Anosmia/epidemiology , COVID-19/epidemiology , Dysgeusia/epidemiology , Adult , Anosmia/blood , Anosmia/physiopathology , Anosmia/virology , COVID-19/blood , COVID-19/diagnosis , COVID-19/physiopathology , Case-Control Studies , Dysgeusia/blood , Dysgeusia/physiopathology , Dysgeusia/virology , Female , Humans , India/epidemiology , Male , Middle Aged , Multivariate Analysis , Odds Ratio , Pandemics , Platelet Count , Real-Time Polymerase Chain Reaction , Retrospective Studies , Rhinitis/epidemiology , Rhinitis/etiology , SARS-CoV-2/isolation & purification , Thrombocytopenia/epidemiology , Thrombocytopenia/etiology
6.
Am J Otolaryngol ; 41(5): 102604, 2020.
Article in English | MEDLINE | ID: covidwho-628588

ABSTRACT

OBJECTIVES: The role of topical anti-infectives in acute exacerbations of chronic rhinosinusitis is controversial. Povidone-iodine is an anti-bacterial and anti-viral that is affordable and available over-the-counter and may demonstrate advantages over mupirocin as a sinus irrigation therapy. The objective was to compare povidone-iodine or mupirocin versus saline sinus irrigations for sinusitis exacerbations in post-surgery subjects as well as to assess tolerability of povidone-iodine sinus irrigations. MATERIALS AND METHODS: This was a prospective single-blinded (clinician only) randomized controlled trial. Subjects were post-surgery with acute exacerbations of chronic rhinosinusitis and gram-positive bacteria on culture. They received povidone-iodine, mupirocin, or saline sinus irrigations, twice daily for 30 days. Outcomes were post-treatment culture negativity (primary) and Sinonasal Outcome Test-20 and Lund-Kennedy endoscopic score change (secondary). RESULTS: Of the 62 subjects analyzed, post-treatment culture negativity rate was higher in the MUP (14/20, 70%) group compared to the PI (9/21, 43%) and SAL (9/19, 47%) groups, although this was not significant (p = 0.29). Povidone-iodine sinus irrigations at the 1% concentration were very well-tolerated, similar to saline irrigations. There were no significant differences in Sinonasal Outcome Test-20 score (povidone-iodine -0.3 [-0.6, 0.05] vs. mupirocin -0.3 [-0.7, 0.05] vs. saline -0.4 [-0.8, 0.05]; p = 0.86) or Lund-Kennedy endoscopic score (povidone-iodine -3.5 [-7, -0.5] vs. mupirocin -2 [-4, 2] vs. saline -3 [-5, 0]; p = 0.45) change. No serious adverse effects were reported. CONCLUSIONS: In patients who have had prior sinus surgery with acute exacerbations of CRS and gram-positive bacteria on culture, mupirocin sinus irrigations achieved a better post-treatment culture "control" rate compared to saline and povidone-iodine. In addition, 1% povidone-iodine solution was well-tolerated as a sinus irrigation and may represent a feasible method for temporarily disinfecting the sinonasal cavity of bacteria and viruses such as COVID-19.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Mupirocin/therapeutic use , Postoperative Complications/drug therapy , Povidone-Iodine/therapeutic use , Rhinitis/drug therapy , Sinusitis/drug therapy , Adult , Anti-Infective Agents, Local , Chronic Disease , Female , Humans , Male , Middle Aged , Postoperative Complications/diagnosis , Postoperative Complications/etiology , Prospective Studies , Rhinitis/diagnosis , Rhinitis/etiology , Saline Solution , Single-Blind Method , Sinusitis/diagnosis , Sinusitis/etiology , Therapeutic Irrigation
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