P233 COVID-19-a ssociated Mucormycosis: an experience of invasive fungal sinusitis from a tertiary care referral center in Northern India

 

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM

Objectives

The study was aimed to determine the patient demographics, risk factors, which include comorbidities, presenting symptoms and signs, medications used to treat COVID-19, species of Mucorales isolated, and the management outcome of COVID-19-associated mucormycosis.

Methods

It was a 6-month retrospective, propensity score-matched, comparative study conducted at a tertiary care center, involving 124 patients with COVID-19 associated mucormycosis admitted between April and September 2021, who were suffering from or had a history of COVID-19 infection.

Results

Among the 124 patients, 87 were male, and 37 were female. A total of 72.6% of patients received steroids, while 73.4% received antibiotics, and 55.6% received oxygen during COVID-19 management. The most common comorbidities were diabetes mellitus (83.9%) and hypertension (30.6%). A total of 92.2% had mucor, 16.9% had Aspergillus, 12.9% had both, and one patient had hyalohyphomycosis on fungal smear and culture. The comparative study showed the significant role of serum ferritin, glycemic control, steroid use, and duration in COVID-19-associated invasive fungal disease (P <.001). Headache and facial pain (68, 54.8%) were the most common symptoms. The most involved sinonasal site was the maxillary sinus (90, 72.6%). Direct KOH microscopy for fungus was positive in 100% of the cases, 82.2% were Mucorales; 12.9% showed mixed fungal hyphae (mucormycetes and Aspergillus spp.), 4% Aspergillus and hyaline septate non-Aspergillus fungus hyphae were seen in 0.8%. Mucoraceous fungi isolated were R. arrhizus, R. microsporus, R. homothallicus, Rhizomucor pusillus, and Leithemia corymbifera. The overall survival rate at the 3-month follow-up was 79.9%.

Conclusion

COVID-19-related aggressive inflammatory response, uncontrolled glycemic level, and rampant use of steroids are the most important predisposing factors in developing COVID-19-associated invasive fungal sinusitis caused by Mucorales. A high index of suspicion, aggressive surgical and antifungal therapy resulted in the successful outcomes for most of the patients.

The Spectrum of Invasive Fungal Sinusitis in COVID-19 Patients: Experience from a Tertiary Care Referral Center in Northern India

This study aimed to determine the patient demographics, risk factors, which include comorbidities, medications used to treat COVID-19, and presenting symptoms and signs, and the management outcome of COVID-19-associated invasive fungal sinusitis. A retrospective, propensity score-matched, comparative study was conducted at a tertiary care center, involving 124 patients with invasive fungal sinusitis admitted between April 2021 and September 2021, suffering from or having a history of COVID-19 infection. Among the 124 patients, 87 were male, and 37 were female. A total of 72.6% of patients received steroids, while 73.4% received antibiotics, and 55.6% received oxygen during COVID-19 management. The most common comorbidities were diabetes mellitus (83.9%) and hypertension (30.6%). A total of 92.2% had mucor, 16.9% had aspergillus, 12.9% had both, and one patient had hyalohyphomycosis on fungal smear and culture. The comparative study showed the significant role of serum ferritin, glycemic control, steroid use, and duration in COVID-19-associated invasive fungal disease (p < 0.001). Headache and facial pain (68, 54.8%) were the most common symptoms. The most involved sinonasal site was the maxillary sinus (90, 72.6%). The overall survival rate at the three-month follow-up was 79.9%. COVID-19-related aggressive inflammatory response, uncontrolled glycemic level, and rampant use of steroids are the most important predisposing factors in developing COVID-19-associated invasive fungal sinusitis.

Is the Tradition of Nasal Packing Just an Illusion of Permanence or a Necessary Evil?

Background Nasal packing after an endoscopic endonasal approach (EEA) is a routine practice. There is a very urgent need for a level-I recommendation pertaining to the necessity of these packs and, if required, then the timing of its removal. However, the opponents of this practice mention its various disadvantages, among which infection is the most important. In our study, we have evaluated the bacteriological profile of the nasal packs, following endoscopic anterior skull base surgery.

Materials and Methods Thirty consecutive cases (2017–18) of anterior skull base pathologies operated by EEA were included, and preoperative nasal swab and postoperative period, the nasal packs were sent for microbiological culture. The colony of bacteria grew, and clinical condition, histopathology and demographic profile of the patients were noted.

Results Of the 30 patients, 40% (n = 12) showed an increase in nasal bacterial flora after packing, with methicillin-sensitive coagulase negative Streptococcus (MSCNS) in three patients, Escherichia fecalis (E. fecalis) in three patients, and methicillin-resistant coagulase negative Streptococcus (MRCNS) in two patients. Other rare organisms grew, including Acinetobacter baumanni with E. fecalis, Acinetobacter baumanni with MRCNS, Citrobacter koseni, and Escherichia fecium (E. fecium) with MRCNS and MRSA in one patient each.

Conclusion Packing increases the bacterial load of the nasal cavity. This bacterial flora can be a potential source of meningitis. We advocate that packing should be avoided, and if at all required, should be removed within 3 days. A routine practice of nasal swab in the preoperative period and culture of the packs may give information on the possible organism that may cause meningitis and the appropriate antibiotic sensitivity of the organism.

Transnasal endoscopic repair of pediatric meningoencephalocele

Introduction:

Encephaloceles in relation to the nose are rare lesions affecting the skull base. In the pediatric population, majority are congenital lesions manifesting as nasal masses requiring surgical intervention.

Materials and Methods:

A retrospective study of 6 consecutive patients below 12 years of age with intranasal meningoencephalocele treated by endonasal endoscopic approach at our tertiary centre was done. The follow up period ranged from 6 months to 2 years. A detailed clinical and radiological evaluation of these cases was done. Endonasal endoscopic repair (gasket seal/fat plug) was carried out in all cases.

Results:

Out of 6 patients, 4 patients had post-traumatic and rest 2 cases had congenital meningo-encephaloceles. All patients were asymptomatic in post-operative follow up period. One patient had minor complication of nasal alar collapse due to intra-operative adherence of encephalocele to cartilaginous framework.

Conclusion:

Transnasal endoscopic repair of anterior skull base meningoencephalocele is a minimally invasive single stage surgery, and has advantage in terms of lesser hospital stay, cost of treatment, and better cosmesis. The repair technique should be tailored to the size of defect to provide a water-tight seal for better outcome.

Carbon nanotube reinforced polylactide-caprolactone copolymer: mechanical strengthening and interaction with human osteoblasts in vitro

This study proposes the use of carbon nanotubes (CNTs) as reinforcement to enhance the mechanical properties of a polylactide-caprolactone copolymer (PLC) matrix. Biological interaction of PLC-CNT composites with human osteoblast cells is also investigated. Addition of 2 wt % CNT shows very uniform dispersion in the copolymer matrix, whereas 5 wt % CNT shows severe agglomeration and high porosity. PLC-2 wt % CNT composite shows an improvement in the mechanical properties with an increase in the elastic modulus by 100% and tensile strength by 160%, without any adverse effect on the ductility up to 240% elongation. An in vitro biocompatibility study on the composites shows an increase in the viability of human osteoblast cells compared to the PLC matrix, which is attributed to the combined effect of CNT content and surface roughness of the composite films.