graduate student
Stavropol, Stavropol, Russian Federation
employee
City Clinical Emergency Hospital
employee
Stavropol, Stavropol, Russian Federation
employee from 01.01.2015 until now
Stavropol State Medical University (kafedra hirurgicheskoy stomatologii i chelyustno-licevoy hirurgii, assistent)
employee from 01.01.2023 until now
Stavropol, Stavropol, Russian Federation
employee
City Clinical Emergency Hospital (clinical diagnostic laboratory, Laboratory manager)
Stavropol, Stavropol, Russian Federation
UDK 61 Медицина. Охрана здоровья. Пожарное дело
GRNTI 76.29 Клиническая медицина
Subject. Postcovid necrosis of the maxillofacial region is one of the severe consequences of a new coronavirus infection, the etiology and pathogenesis of which are not fully understood. A large number of researchers emphasize the leading role of molds in the development of this complication, which they characterize as COVID-19-associated rhino-orbito-cerebral mycosis. However, there is a point of view that the inflammatory process in post-covid necrosis can also be caused by other pathogens - saprophytic microflora. The aim of the study was to evaluate the results of microbiological examination in patients with Postcovid necrosis of the maxillofacial region and in the risk group for this complication. Methodology. The main study group consisted of 19 patients with signs of osteonecrosis of the bones of the facial skeleton and inflammatory lesions of the paranasal sinuses after suffering a coronavirus infection (Postcovid necrosis of the maxillofacial region). Control group (risk group) - 32 patients with severe COVID-19 without the above manifestations. A microbiological study was performed - a smear from the mucous membrane in the region of the middle nasal passage, smear microscopy, seeding on standard and elective (Saburo) media before treatment. Data were compared using Fisher's exact test for p<0.05. Results. In the main group there were 19 people - 10 men (52.63%), 9 women (47.37%), aged 54 to 73 years, in the control group - 18 (56.25%) men, 14 (43, 75%) women, 52 to 83 years old. In the main group, Streptococcus viridans, Klebsiella pneumonia and Mucor spp. were detected significantly more often (p<0.05), and Staphylococcus aureus was found in the risk group. Mycelium of mold fungi was found only in 3 patients of the main group, in the rest the absence of fungal invasion was confirmed cytologically and pathohistologically. Conclusions. The data obtained confirm the assumption that the inflammatory process in Postcovid necrosis of the maxillofacial region can be caused by various pathogens and is an opportunistic nosocomial infection. It is required to monitor patients at risk and timely treatment if they develop specific symptoms.
jaw necrosis, sinusitis, COVID-19, mucormycosis, post-covid osteonecrosis
1. Suresh A., Joshi A., Desai A.K., Juturu U., Kurian D.J., Jain P., Kulkarni R.D., Kumar N. Covid-19-associated fungal osteomyelitis of jaws and sinuses: An experience-driven management protocol. Med Mycol. 2022; 60(2): myab082. DOI:https://doi.org/10.1093/mmy/myab082.
2. Mehta S., Pandey A. Rhino-Orbital Mucormycosis Associated With COVID-19. Cureus. 2020; 12(9): 10726. DOI:https://doi.org/10.7759/cureus.10726.
3. Baranova I.B., Yaremenko A.I., Zubareva A.A., Karpischenko S.A., Popova M.O., Kurus A.A., Portnov G.V., Pinegina O.N., Lukina O.V., Malyarevskaya M.V., Kalakuckiy I.N., Ilyukhina M.O., Klimko N.N. Mucormycosis of the bones of the facial skull, nasal cavity and paranasal sinuses in patients with COVID-19. Clinical Microbiology and Antimicrobial Chemotherapy. 2021; 23(4): 347-358. (in Russ.) doi:https://doi.org/10.36488/cmac.2021.4.347-358.
4. Khostelidi S.N., Zaytsev V.A., Vartanyan S.A., Nikitin N.A., Evtukh G.N., Gilalov M.N., Portnov G.V., Zubareva A.A., Baranova I.B., Bogomolova T.S., Avdeenko Yu.L., Shadrivova O.V., Desyatik E.A., Shagdileeva E.V., Borzova Yu.V., Krivolapov Yu.A., Vasilyeva N.V., Klimko N.N. Mucormycosis in patients with COVID-19 in Russia: the results of a prospective multi-center study. Journal Infectology. 2022; 14(2): 116-127. (in Russ.) doi:https://doi.org/10.22625/2072-6732-2022-14-2-116-127.
5. Hoenigl M., Seidel D., Carvalho A., Rudramurthy S.M., Arastehfar A., Gangneux J.P., Nasir N., Bonifaz A., Araiza J., Klimko N., Serris A., Lagrou K., Meis J.F., Cornely O.A., Perfect J.R., White P.L., Chakrabarti A.; ECMM and ISHAM collaborators. The emergence of COVID-19 associated mucormycosis: a review of cases from 18 countries. Lancet Microbe. 2022; 3(7): 543-552. doi:https://doi.org/10.1016/S2666-5247(21)00237-8.
6. Eremin D.A., Khelminskaya N.M., Kravets V.I., Posadskaya A.V., Pletayanova I.V., Kravets A.V., Faustova E.E., Nikolskaya I.A. Risks and possible complications in maxillofacial surgery patients during or after coronavirus infection. Medical alphabet. 2022;(2):67-70. (in Russ.) doi:https://doi.org/10.33667/2078-5631-2022-2-67-70.
7. Shahinian G.G., Kareva S.A., Markarov A.E., Sharov A.V., Lyubimov S.N., Sarshor S.V. Osteomyelitis of the skull bones in post COVID-19 patients. Rossiiskii neirokhirurgicheskii zhurnal imeni professora A.L. Polenova. 2022; 14(2): 160-166. (in Russ.)
8. WHO Coronavirus (COVID-19) Dashboard, 2023. URL: https://covid19.who.int/info (accessed 25.03.2022).
9. Kurilin B.I., Kiselevskaya-Babinina V.Y., Kuzmicheva Y.V., Shapoval A.V., Drozdova N.E., Popugayev K.A. The Impact of Vaccination on Disease Course and Outcome in Intensive Care Patients With COVID-19. Russian Sklifosovsky Journal "Emergency Medical Care". 2022;11(4):610-623. (in Russ.) doi:https://doi.org/10.23934/2223-9022-2022-11-4-610-623.
10. Ambereen A., Rahman S.A., Rehman S., Zaidi K., Arif S.H. Mandibular mucormycosis following SARS-CoV-2 infection - A case report and review of literature. Clin Infect Pract. 2021; 12: 100099. doi:https://doi.org/10.1016/j.clinpr.2021.100099.
11. Spevak E.M., Hristoforando D.J., Ivanjuta S.O., Spevak R.S. Clinical and radiological peculiarities of postcovid osteomyelitis of the maxillofacial region. Stomatology for All / Int. Dental Review. 2023; 1(102): 4-9 (in Russ.). doi:https://doi.org/10.35556/idr-2023-1(102)4-9.
12. Chulakova N.A., Potapov A.F., Chulakov K.V., Ivanova A.A. Characteristics and results of the specialized anesthesiology and intensive care for patients with covid-19 in the Republic of Sakha (Yakutia). Yakut medical journal. 2022; 3(79):46-50 (in Russ.) doi:https://doi.org/10.25789/YMJ.2022.79.12.
13. Eremin A.V., Chekhonatskaya M.L., Nikolenko V.N., Ilyasova E.B., Smolkina E.P., Chekhonatskiy A.A., Kondratieva O.A., Gavryushova L.V. Postocclusive necrosis of the maxillofacial region. REJR 2022; 12(4):22-29. (in Russ.) doi:https://doi.org/10.21569/2222-7415-2022-12-4-22-29.
14. Elizbaryan IS, Lazareva LA, Semenov FV, Chuprinenko LM, Vartanyan SA, Baiduev TsZ, Strelyaev AA, Egorov NS, Savosin YuV, Skibitsky VV. Rhinoorbital mucormycosis in patients with the post-COVID syndrome. Clinical and morphological features. Russian Rhinology. 2023;31(1):66-75. (in Russ.) doi:https://doi.org/10.17116/rosrino20233101166.
15. Savosin Yu.V., Shafranova S.K., Gaivoronskaya T.V., Avdeeva M.G., Vartanyan S.A. Rhinocerebral Form of Invasive Mycosis in COVID-19 Patients: Clinical Course, Diagnosis, Treatment Experience. Kuban Scientific Medical Bulletin. 2022;29(5):63-79. (In Russ.)] doi:https://doi.org/10.25207/1608-6228-2022-29-5-63-79.
16. Balushi AA, Ajmi AA, Sinani QA, Menon V, Berieki ZA, Shezawi AA, Azri SA, Rashdi AA, Jardani AA, Baluki TA, Ghaithi SA, Reesi AA, Al-Za'abi AT, Al' Balushi MA, Maqbali TA. COVID-19-Associated Mucormycosis: An Opportunistic Fungal Infection. A Case Series and Review. Int J Infect Dis. 2022; 121: 203-210. doi:https://doi.org/10.1016/j.ijid.2022.05.005.
17. Mañón VA, Balandran S, Young S, Wong M, Melville JC. COVID-Associated Avascular Necrosis of the Maxilla-A Rare, New Side Effect of COVID-19. J Oral Maxillofac Surg. 2022;80(7):1254-1259. DOI:https://doi.org/10.1016/j.joms.2022.04.015.
18. Al-Mahalawy H, El-Mahallawy Y, Dessoky NY, Ibrahim S, Amer H, Ayad HM, El Sherif HM, Shabaan AA. Post-COVID-19 related osteonecrosis of the jaw (PC-RONJ): an alarming morbidity in COVID-19 surviving patients. BMC Infect Dis. 2022;22(1):544. DOI:https://doi.org/10.1186/s12879-022-07518-9.
19. Turbin RE, Wawrzusin PJ, Sakla NM, Traba CM, Wong KG, Mirani N, Eloy JA, Nimchinsky EA. Orbital cellulitis, sinusitis and intracranial abnormalities in two adolescents with COVID-19. Orbit. 2020;39(4):305-310. DOI:https://doi.org/10.1080/01676830.2020.1768560.
20. Slavkova N, Nedevska M. Aseptic osteonecrosis of the maxilla after severe COVID-19 infection and its treatment. Radiol Case Rep. 2022;17(9):3228-3232. DOI:https://doi.org/10.1016/j.radcr.2022.06.009
