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Sheikh A, Capello C, AlMubarak Z, Dzioba A, You P, Nashid N, Barton M, Husein M, Strychowsky JE, Graham ME. Changes in operative otolaryngology infections related to the COVID19 pandemic: A retrospective cohort study. Int J Pediatr Otorhinolaryngol 2023; 171:111650. [PMID: 37437498 DOI: 10.1016/j.ijporl.2023.111650] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/22/2023] [Accepted: 07/07/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND Pediatric emergency admissions fell significantly during the COVID-19 pandemic. This study investigated the changes in severe infectious complications managed by otolaryngology between the pre-pandemic period and the first year of the pandemic to determine if COVID-19 or related public health measures influenced the rate or severity of presentations managed in otolaryngology. METHODS A retrospective chart review was conducted on pediatric patients who presented with severe infectious otolaryngology presentations (acute mastoiditis, deep neck space abscesses, and orbital complications of sinusitis) over the pre-pandemic (March 2018-February 2020) and early pandemic (March 2020-February 2021) periods. Patient characteristics, details of presentation, treatment, and outcomes were extracted from patients' charts. Independent samples t-tests/Mann-Whitney U-tests for continuous variables and Pearson chi-squared tests/Fisher's exact test for categorical variables were conducted to compare the pre vs early pandemic groups. RESULTS There were 93 pre-pandemic and 28 early pandemic presentations. The monthly case average was significantly lower during the early pandemic period than the 2 years prior [3.58 (2.80) vs 2.00 (2.00), P = .045]. The average monthly frequency of presentations for deep neck space abscess and mastoiditis were significantly higher in the pre-pandemic group when compared to the early pandemic group [1.96 (±0.33) vs 1.33 (±0.48), P = .049; .71 (±0.26) vs 0.17 (±0.41), P = .01, respectively]. The early pandemic group was significantly younger (3.81 vs 6.04 years, P = .005), however there were no differences in gender, length of admission, and days from symptom onset to presentation between the two groups (P > .05). The early pandemic group had significantly elevated inflammatory markers on presentation [CRP, WBC, neutrophils (P = .02, P = .02, P = .04, respectively)] compared to the pre-pandemic group. CONCLUSION The COVID-19 pandemic has had an effect on severe infectious complications of ENT pathologies, including decreased average monthly cases during the early pandemic, younger age at presentation, and elevated inflammatory markers.
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Affiliation(s)
- Adeel Sheikh
- Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, ON, N6A 5C1, Canada
| | - Chris Capello
- Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, ON, N6A 5C1, Canada
| | - Zaid AlMubarak
- Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, ON, N6A 5C1, Canada; Department of Otolaryngology - Head and Neck Surgery, London Health Sciences Centre, Box 5010, 800 Commissioners Road E, London, ON, N6A 5W9, Canada
| | - Agnieszka Dzioba
- Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, ON, N6A 5C1, Canada; Department of Otolaryngology - Head and Neck Surgery, London Health Sciences Centre, Box 5010, 800 Commissioners Road E, London, ON, N6A 5W9, Canada
| | - Peng You
- Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, ON, N6A 5C1, Canada; Department of Otolaryngology - Head and Neck Surgery, London Health Sciences Centre, Box 5010, 800 Commissioners Road E, London, ON, N6A 5W9, Canada
| | - Nancy Nashid
- Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, ON, N6A 5C1, Canada; Division of Infectious Disease, Department of Pediatrics, London Health Sciences Centre, 800 Commissioners Road E, London, ON, N6A 5W9, Canada
| | - Michelle Barton
- Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, ON, N6A 5C1, Canada; Division of Infectious Disease, Department of Pediatrics, London Health Sciences Centre, 800 Commissioners Road E, London, ON, N6A 5W9, Canada
| | - Murad Husein
- Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, ON, N6A 5C1, Canada; Department of Otolaryngology - Head and Neck Surgery, London Health Sciences Centre, Box 5010, 800 Commissioners Road E, London, ON, N6A 5W9, Canada
| | - Julie E Strychowsky
- Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, ON, N6A 5C1, Canada; Department of Otolaryngology - Head and Neck Surgery, London Health Sciences Centre, Box 5010, 800 Commissioners Road E, London, ON, N6A 5W9, Canada
| | - M Elise Graham
- Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, ON, N6A 5C1, Canada; Department of Otolaryngology - Head and Neck Surgery, London Health Sciences Centre, Box 5010, 800 Commissioners Road E, London, ON, N6A 5W9, Canada.
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Giannitto C, Bonifacio C, Esposito S, Ammirabile A, Mercante G, De Virgilio A, Spriano G, Heffler E, Lofino L, Politi LS, Balzarini L. Sudden neck swelling with rash as late manifestation of COVID-19: a case report. BMC Infect Dis 2021; 21:232. [PMID: 33639889 PMCID: PMC7912866 DOI: 10.1186/s12879-021-05911-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 02/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although there are reports of otolaryngological symptoms and manifestations of CoronaVirus Disease 19 (COVID-19), there have been no documented cases of sudden neck swelling with rash in patients with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection described in literature. CASE PRESENTATION We report a case of a sudden neck swelling and rash likely due to late SARS-CoV-2 in a 64-year-old woman. The patient reported COVID-19 symptoms over the previous three weeks. Computed Tomography (CT) revealed a diffuse soft-tissue swelling and edema of subcutaneous tissue, hypodermis, and muscular and deep fascial planes. All the differential diagnoses were ruled out. Both the anamnestic history of the patient's husband who had died of COVID-19 with and the collateral findings of pneumonia and esophageal wall edema suggested the association with COVID-19. This was confirmed by nasopharyngeal swab polymerase chain reaction. The patient was treated with lopinavir/ritonavir, hydroxychloroquine and piperacillin/tazobactam for 7 days. The neck swelling resolved in less than 24 h, while the erythema was still present up to two days later. The patient was discharged after seven days in good clinical condition and with a negative swab. CONCLUSION Sudden neck swelling with rash may be a coincidental presentation, but, in the pandemic context, it is most likely a direct or indirect complication of COVID-19.
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Affiliation(s)
- Caterina Giannitto
- Department of Diagnostic Radiology, Humanitas Clinical and Research Center IRCCS, Via Alessandro Manzoni 56, 20089 Rozzano, Milan, Italy.
| | - Cristiana Bonifacio
- Department of Diagnostic Radiology, Humanitas Clinical and Research Center IRCCS, Via Alessandro Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Susanna Esposito
- Paediatric Clinic, Pietro Barilla Children's Hospital, Department of Medicine and Surgery, University of Parma, 43121, Parma, Italy
| | - Angela Ammirabile
- Residency Program in Radiology, Humanitas University, Pieve Emanuele, 20072, Milan, Italy
| | - Giuseppe Mercante
- Otorhinolaryngology Unit, Humanitas University, Humanitas Clinical and Research Centre - IRCCS, Rozzano, 20089, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072, Milan, Italy
| | - Armando De Virgilio
- Otorhinolaryngology Unit, Humanitas University, Humanitas Clinical and Research Centre - IRCCS, Rozzano, 20089, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072, Milan, Italy
| | - Giuseppe Spriano
- Otorhinolaryngology Unit, Humanitas University, Humanitas Clinical and Research Centre - IRCCS, Rozzano, 20089, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072, Milan, Italy
| | - Enrico Heffler
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072, Milan, Italy
| | - Ludovica Lofino
- Residency Program in Radiology, Humanitas University, Pieve Emanuele, 20072, Milan, Italy
| | - Letterio Salvatore Politi
- Department of Diagnostic Radiology, Humanitas Clinical and Research Center IRCCS, Via Alessandro Manzoni 56, 20089 Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072, Milan, Italy
| | - Luca Balzarini
- Department of Diagnostic Radiology, Humanitas Clinical and Research Center IRCCS, Via Alessandro Manzoni 56, 20089 Rozzano, Milan, Italy
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