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Osteomyelitis of Jaw Bone due to Aspergillosis in Post-COVID-19 Patients: An Observational Study
Abhay Datarkar1, Vandana Gadve1, Akshay Dhoble2
1Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Nagpur, MS India.
Background:
In the second wave of COVID-19 pandemic, there has been an increase in number of cases with Post-COVID-19 fungal osteomyelitis of jaws. Aspergillosis was found to be one of the causes of osteomyelitis of jaw bones in these patients.
Aim:
To evaluate the incidence and pattern of osteomyelitis of jaw due to aspergillosis in post-COVID-19 patients and to discuss the management protocol of the same.
Method:
Data were obtained at our institution from the period of January 2021 to June 2021. Patients of all age groups with Post-COVID-19 osteomyelitis of jaw due to aspergillosis and those with combined aspergillosis and mucormycosis infection were included. Patients having rhino-orbito-cerebral fungal infection were excluded.
Results:
A total of 47 patients reported to our center. Demographically the average age of the patients was 49.11 years with 72% being males. All 47 patients (N = 100%) had received steroids. 21 of them (N = 44.7%) had diabetes mellitus and 14 (N = 29.8%) patients had other comorbidities. Out of 47 patients, 42 (N = 89.7%) patients were diagnosed with aspergillosis and the remaining 5 (N = 10.3%) cases had a mixed fungal infection of mucormycosis and aspergillosis. On fungal culture Aspergillus flavus was the most common species detected followed by Aspergillus niger and Aspergillus fumigatus. All patients were treated with oral Voriconazole and local surgical debridement. Prompt laboratory testing such as a timely KOH mount, galactomannan test, beta-D-glucan test, histopathology of tissue specimens could help to give an early and definitive diagnosis. The mortality rate we encountered in this study was nil.
Conclusions:
Early and definitive diagnosis and immediate initiation of antifungal drug therapy and surgical intervention will significantly reduce the rate of morbidity and mortality.
Insights
Post-COVID-19 fungal osteomyelitis of the jaws, particularly aspergillosis, increased during the second pandemic wave. Early diagnosis and treatment with antifungals and surgery are crucial for reducing complications.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Oral and Maxillofacial Surgery
Background:
- The second wave of the COVID-19 pandemic saw a rise in cases of post-COVID-19 fungal osteomyelitis affecting the jaws.
- Aspergillosis emerged as a significant cause of this jaw osteomyelitis in affected patients.
Purpose of the Study:
- To determine the incidence and characteristics of jaw osteomyelitis caused by aspergillosis in post-COVID-19 patients.
- To outline a management protocol for this condition.
Main Methods:
- A retrospective analysis of 47 patients diagnosed with post-COVID-19 jaw osteomyelitis between January 2021 and June 2021.
- Inclusion criteria encompassed all age groups with aspergillosis or mixed fungal infections; exclusion criteria included rhino-orbito-cerebral fungal infections.
- Diagnostic methods included KOH mount, galactomannan test, beta-D-glucan test, and histopathology; treatment involved oral Voriconazole and surgical debridement.
Main Results:
- Out of 47 patients, 89.7% had aspergillosis, and 10.3% had a mixed infection with mucormycosis.
- The most common species identified was Aspergillus flavus, followed by Aspergillus niger and Aspergillus fumigatus.
- All patients received oral Voriconazole and surgical debridement, with no mortality reported.
Conclusions:
- Prompt laboratory diagnosis and immediate initiation of antifungal therapy and surgical intervention are vital.
- Effective management significantly reduces morbidity and mortality rates associated with post-COVID-19 fungal jaw osteomyelitis.
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