Covid-19 Associated Fungal Osteomyelitis of Jaws and Sinuses: An experience driven management protocol
Med Mycol. 2022 Jan 24:myab082. doi: 10.1093/mmy/myab082. Online ahead of print.
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 in a tertiary care centre in South India. Demographic details, COVID-19 infection and treatment history, time taken for initiation of symptoms after COVID-19 diagnosis, medical history, clinical features were recorded. All the patients were managed with a standard diagnostic and intervention protocol including pre-operative and post-operative administration of Inj. Amphotericin B 50 mg (liposomal) and early aggressive surgical debridement. Thirty-nine (78%) patients were diagnosed with CAFOJS out of 50 osteomyelitis patients reported to our centre. 32 patients gave history of diabetes (82%) and 3 patients (8%) were diagnosed as diabetic on reporting to us. 21 patients (54%) patients 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 3 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.