Mohammadi Kouser, Mohiyuddin S M Azeem, Prasad K C, Rajan Akshaya, Indu Varsha Gopinath, Natrajan Arvind, Sakalecha Anil K, Jose Diana Ann
Sri Devaraj Urs Academy of Higher Education and Research, Tamaka, Kolar, India.
Indian J Otolaryngol Head Neck Surg. 2024 Feb;76(1):55-63. doi: 10.1007/s12070-023-04077-6. Epub 2023 Jul 28.
The second wave of COVID pandemic was associated with an outbreak of Mucormycosis. The mortality rate of Mucormycosis reaches 50-80% in cases with orbital and intracranial extension (Fadda in Acta Otorhinolaryngol Ital 41:43-50, 2021). In this outbreak we found that few of these patients had bacterial invasive sinusitis mimicking fungal sinusitis. Amphotericin the only effective drug against Mucormycosis is highly toxic and expensive and not indicated in bacterial sinusitis. Our aim was to determine the exact etiologic agent, predisposing factors and outcome of treatment of COVID associated invasive sinusitis presenting with orbital complications. It is a retrospective observational study done in 33 patients with orbital complications in COVID associated invasive sinusitis. Demographic details of the patients and clinical presentation were documented. Rhinological examination was done and a nasal swab was taken for KOH mount along with Gram`s stain and Culture and Sensitivity. All Patients underwent radiological evaluation by contrast enhanced computed tomography (CECT) or MRI. Liposomal Amphotericin B was started. Surgical debridement done. Amphotericin-B was stopped in cases reported negative for fungal elements and antibiotics administered for two weeks. Outcome of treatment was documented. A total of 33 patients were included in the study. 48.5% patients were found to have bacterial infection and 27.3% patient's fungal infections and 24.2% mixed infections.Eschar formation, necrotic tissue, erosion of the lamina papyracea was seen in both Klebsiella (33.3%) and Staphylococcal infections (16.6%) similar to Mucor and mixed infections. Persistent opthalmoplegia and deterioration of vision was associated with Mucor and mixed infections. However improvement in proptosis, ptosis, ophthalmoplegia, and vision was observed in cases associated with bacterial invasive sinusitis. Invasive bacterial sinusitis was under diagnosed during second wave of COVID. Identification of invasive bacterial sinusitis can help in de-escalation of treatment.
新冠疫情的第二波与毛霉菌病的爆发有关。在眼眶和颅内扩展的病例中，毛霉菌病的死亡率达到50%-80%（法达，《意大利耳鼻喉科学报》41:43-50，2021年）。在这次疫情中，我们发现这些患者中很少有人患有模仿真菌性鼻窦炎的细菌性侵袭性鼻窦炎。两性霉素是唯一对抗毛霉菌病有效的药物，但毒性大且昂贵，对细菌性鼻窦炎无效。我们的目的是确定伴有眼眶并发症的新冠相关侵袭性鼻窦炎的确切病原体、易感因素和治疗结果。这是一项对33例伴有眼眶并发症的新冠相关侵袭性鼻窦炎患者进行的回顾性观察研究。记录了患者的人口统计学细节和临床表现。进行了鼻科检查，并采集鼻拭子进行氢氧化钾涂片、革兰氏染色以及培养和药敏试验。所有患者均通过增强计算机断层扫描（CECT）或磁共振成像（MRI）进行了影像学评估。开始使用脂质体两性霉素B。进行了手术清创。对于真菌成分检测呈阴性的病例，停用两性霉素B，并给予抗生素治疗两周。记录了治疗结果。该研究共纳入33例患者。发现48.5%的患者有细菌感染，27.3%的患者有真菌感染，24.2%的患者有混合感染。在克雷伯菌（33.3%）和葡萄球菌感染（16.6%）中均可见焦痂形成、坏死组织、纸样板侵蚀，与毛霉菌感染和混合感染相似。持续性眼球运动障碍和视力恶化与毛霉菌感染及混合感染有关。然而，在细菌性侵袭性鼻窦炎相关病例中，观察到眼球突出、上睑下垂、眼球运动障碍和视力有所改善。在新冠疫情的第二波期间，侵袭性细菌性鼻窦炎未得到充分诊断。识别侵袭性细菌性鼻窦炎有助于降低治疗强度。
