Lobe Abscess Research Articles

Surgical treatment of extraintestinal amoebiasis with development of right lobe liver abscess: case study

The treatment of extraintestinal amoebiasis is a major surgical concern given the low prevalence in the Republic of Belarus and consequently difficult diagnosis. In this article, we present our own experience with the surgical treatment of a patient with an amoebic liver abscess. The patient underwent laparoscopy guided drainage of the abscess of the right lobe of the liver according to the technique developed in the clinic. A puncture-drainage system consisting of a Foley catheter and a guide stylet was used. The patient was discharged in satisfactory condition for outpatient treatment and observation by a surgeon, a general practitioner, and an infectious disease specialist. There were no repeated visits or admissions. The presented case emphasizes the importance of combined treatment of amoebic liver abscesses using percutaneous drainage and conservative therapy with amoebicidal drugs such as metronidazole.

Pyogenic liver abscess due to Burkholderia pseudomallei in immunocompetent patient from Garhwal region of Uttarakhand – A case report

We report a case of liver abscess due to Burkholderia pseudomallei in a 45-year-old, non-diabetic patient from the Garhwal region of Uttarakhand. The patient reported chief complaints of abdominal pain and fever. Ultrasonography and contrast-enhanced computed tomography of the whole abdomen were suggestive of the left liver lobe abscess. Pus was aspirated from the abscess and sent for culture and sensitivity. Growth on the culture plate was identified as B. pseudomallei; the patient was then treated with appropriate antibiotics and discharged in stable condition. Diagnosis of pseudomallei infection requires a high index of suspicion among clinicians as well as laboratory specialists. Early identification of organisms helped clinicians initiate appropriate management in our case.

Otogenic brain abscess as a complication of acute otitis media in an adult female patient – a case report and literature review

<b>Introduction:</b>Ear abscess of the brain occurs in 0.3–1.3/100,000 of the population per year, and about 30% of abscesses are accompanied by other intracranial complications. Such complications can occur in the course of both chronic and acute otitis media, but the latter is extremely rare.<b>Aim:</b> To present a case of temporal lobe abscess in the course of acute otitis media (AOM) in an adult.<b>Case study: </b> The patient was admitted to the Hospital Emergency Department (ED) with symptoms of AOM with purulentleakage from the right ear and disturbance of consciousness. In addition to inflammatory changes in the middle ear, a CTscan showed zones of swelling in the right temporal lobe with suspicion of a forming temporal lobe abscess on the rightside. The treatment administered included urgent anthromastoidectomy and right-sided tympanostomy, as well as empiricalantibiotic therapy. Six days after admission, a follow-up magnetic resonance imaging (MRI) scan of the brain showedprogression of the lesions, complete formation of the abscess, and thrombotic changes in the cerebral venous sinuses werealso described. Further treatment included drainage of the temporal lobe abscess. A significant improvement in generaland neurological condition was achieved. Conservative treatment was continued and regression of the right temporal lobeabscess was achieved, and a follow-up RM study confirmed stable thrombotic lesions in the right transverse sinus.<b>Conclusions:</b> The occurrence of intracranial complications in the course of AOM in adults is extremely rare. Deterioration of the general condition and the appearance of consciousness disturbances in the course of AOM may indicate developing intracranial complications. Implementation of multidisciplinary diagnostic and therapeutic management makes it possible to achieve good therapeutic results.

Costal cartilage as a promising technique for large bronchial fistula closure in fistulous empyema: a case report

BackgroundThere is no high level of evidence for the treatment of fistulous empyema. We report here a promising technique for closure of a bronchopleural fistula using costal cartilage as a bronchial embolus.Case presentationThe patient is a 79-year-old man. A computed tomography scan diagnosed a fistulous empyema associated with perforation of lung abscess of right middle lobe. After thoracoscopic curettage of the right empyema cavity, right middle lung resection and intercostal muscle flap coverage over the bronchial stump were performed. Seven months after the surgery, a bronchopleural fistula developed. Bronchoscopy revealed fistulas in the middle lobe bronchus and B3b. After the open window thoracostomy, the empyema cavity was cleaned up. The empyema cavity remained from the anterior to the lateral thoracic region of the second to fourth ribs. A part of the second through fourth ribs that formed the ceiling of the pleural empyema cavity was removed to create space for skin and thickened parietal pleura to fill the cavity. The costal cartilage obtained from the rib resection was trimmed and harvested to fit into the diameter of the bronchopleural fistula. The free costal cartilage was sutured and fixed with five stitches with 3-0 PDS. The visceral pleura was covered with the thickened parietal pleura and skin and fixed airtight. To maintain a tight seal, a Blake® silicone drain was inserted between the visceral pleura and the thickened parietal pleura, and a suction reservoir was utilized to sustain negative pressure. The drain was removed on the 21st day. As of 21 months postoperatively, the skin and thickened parietal pleura flap has maintained its integrity, and there has been no evidence of pus or recurrence of air leaks.ConclusionIn the case of a fistulous empyema extending anteriorly, costal cartilage can be easily harvested, making it a promising option as a lid for fistula closure.

Recurrent bacterial abscess of the left liver lobe caused by a foreign body (fish bone)

The authors present minimally invasive surgical treatment of recurrent liver abscess caused by migration of fish bone from the upper gastrointestinal tract. Two-stage treatment implied small-caliber transparietal drainage of abscess with evacuation of purulent detritus at the first stage. At the second stage, primary percutaneous approach was transformed into access of sufficient diameter for flexible or rigid optics for visually controlled bone extraction. Foreign body removal through the drainage tube with endoscopic capture under visual control is preferable regarding safety compared to removal under ultrasound and/or X-ray control. Indeed, endoscopic approach is valuable for optimal positioning of the object and prevention of damage to liver parenchyma during extraction.

Endoscopic endonasal trans-cribriform approachfor drainage of frontal lobe abscess in invasivemucormycosis – A case report

Abstract Introduction:Mucormycosis is a belligerent fungal infection that can cause fatal complications. Patients at risk arethose with poorly controlled diabetes mellitus, and similar immunosuppressed states. Tissue invasion and infarctionsecondary to angioinvasion are the pathognomonic features of the disease. The management of brain abscesseshas become increasingly complicated requiring close collaboration between various departments encompassinginfectious disease specialists, neurologists, radiologists and neurosurgeons. ENT surgeons are seldom involved inthe management of brain abscesses, but with the advancements in Endoscopic Sinus Surgery techniques, ENTsurgeons are now treating the skull base, meningeal and brain pathologies.Methods:A case report of a 36-year-old male with complaints of headache, left-sided facial pain, difficultyin opening left eye for 10 days, with a history of one episode of generalized seizure that lasted for 4 min,recently detected type 2 diabetic mellitus. Local examination revealed left-sided nasal crusting and an old palataldefect. KOH mount was positive for mucorales. CT scan PNS revealed left-sided maxillary, ethmoidal, sphenoidalfrontal sinusitis with erosion of left lamina papyracea, left extraconal and intraconal involvement with erosion ofleft cribriform plate. MRI brain revealed additional hyperdensities in both medial frontal, and parietal lobe withdiffusion restriction. The patient underwent left-sided endoscopic sinus surgery with endoscopic endo- nasal trans-cribriform drainage of frontal lobe abscess, with retro bulbar Amphotericin B injection, with a neurosurgical team onstandby in the event of unexpected complications. The eschar and pus drained from the frontal lobe abscess wassent for histopathological examination, culture and sensitivity. The patient was extubated, and the postoperativeperiod was uneventful.

ХИРУРГИЧЕСКОЕ ЛЕЧЕНИЕ ВНЕКИШЕЧНОГО АМЕБИАЗА С РАЗВИТИЕМ АБСЦЕССА ПРАВОЙ ДОЛИ ПЕЧЕНИ

Background. Due to the polymorphism, low prevalence in RB and in turn the difficulty of diagnosis, the treatment of extraintestinal amoebiasis is an important issue of surgery. Objective. To demonstrate the results of surgical treatment of a patient with amebic liver abscess. Material and methods. The article presents its own clinical observation of the surgical treatment of amebic liver abscess. The patient underwent drainage of the right liver lobe abscess under the laparoscopic control according to the method developed in the clinic. Results. The patient was discharged in satisfactory condition for further out-patient follow-up by the surgeon and infectious disease doctor at the place of residence. There were no repeated appeals and admissions. Conclusions. Clinical observation indicates the need for combined treatment of amoebic liver abscesses using external drainage in combination with conservative therapy, including the use of broad-spectrum antibiotics and metronidazole.

Clinical analysis, diagnosis, and treatment strategies for otogenic brain abscesses.

Objective: To explore the clinical features, diagnosis, and treatment strategies for otogenic brain abscesses (OBA). Methods: Clinical data from 10 patients with OBA were analyzed retrospectively. Clinical characteristics, diagnosis, and treatment experiences were summarized. Results: Two were first diagnosed in the Department of Otorhinolaryngology, 5 in Neurosurgery, and 3 in other departments. There were 6 cases of temporal lobe abscess and 4 cases of cerebellar abscesses. Five cases were accompanied by 1 or more intracranial complications. Headache is a common presentation in all cases. The main pathogenic bacteria were anaerobic bacteria. All patients had no previous ear or brain surgery history, and no history of traumatic brain injury, 7 received surgical treatment in the neurosurgery and/or otolaryngology department. Two patients died, the other 8 fully recovered and so were discharged. Conclusions: Diagnosis and treatment of OBA must involve multiple departments. Multidisciplinary consultation (MDT) is crucial to the success of the first OBA diagnosis. The diagnosis and treatment team develops personalized treatment plans by integrating MDT treatment opinions and combining the actual condition of patients, thereby making the diagnosis and treatment of OBA accurate and timely.

Case report: isolated prevotella intermedia causing intracranial infection detected using metagenomic next generation sequencing

BackgroundIsolated Prevotella intermedia, a rare gram-negative, rod-shaped, anaerobic bacterium, is rarely detected in clinical practice. It has been associated with infections of the oral cavity and female genital tract, but has never been detected in cerebrospinal fluid (CSF) of patients in China. Accurate detection of causative pathogens is still an arduous task owing to the difficult conditions of anaerobic bacterial culture. Isolated Prevotella intermedia can be detected by metagenomic next generation sequencing (mNGS) of the CSF. Correct diagnosis and antibiotic treatment can help patients avoid life-threatening events.Case presentationHerein, we describe the case of a 64-year-old Chinese woman who presented with typical features of meningoencephalitis. Routine CSF culture failed to identify the causative pathogen. Isolated Prevotella intermedia was detected by mNGS, and the patient was treated with antibacterial agents including ceftriaxone, vancomycin, moxifloxacin, meropenem, metronidazole, and linezolid. The patient underwent surgical treatment for abscess of left frontal parietal lobe, which was observed on magnetic resonance imaging (MRI) and was suspected to be caused by Prevotella intermedia. It was further confirmed that it was a secondary infection from the oral cavity, and the possible etiology might have been dental surgery. Treatment was rendered to the patient based on metagenomic test result, and her condition improved after two months.ConclusionsThis case highlights the role of mNGS in accurate diagnosis of patients with central nervous system infection. In particular, mNGS can be used to identify rare pathogens and confirm the diagnosis in patients with unknown etiology.

Endoscopic Ultrasound (EUS)-guided Drainage of Caudate Lobe Abscess: A Single Center Experience.

Liver abscess is usually treated with medical therapy. Few patients require drainage of the collection due to large size, certain high-risk location or rupture of the collection. Percutaneous drainage is most commonly used modality for the drainage of such collection. However, caudate lobe poses a unique difficulty in percutaneous drainage due to its deep location. We did a retrospective analysis of all patients with caudate lobe abscess who underwent endoscopic ultrasound (EUS)-guided drainage at our center. We reviewed their indications, technical and clinical success rates of the procedure from 2020 to 2023. We also performed systemic review of published literature till June 12, 2023 showing use of EUS-guided drainage of caudate lobe abscess. Total of 8 patients (age: 37.33 ± 12.8y; Males 62.5%) underwent EUS-guided drainage of caudate lobe collection at our center. Six patients underwent drainage using plastic stents, 1 patient underwent using metal stent, and 1 patient had aspiration of the abscess. Technical success was achieved in all patients. One patient succumbed to background illness and clinical success could be achieved in rest of the patients. In systemic review of literature on EUS-guided drainage of caudate lobe, a total of 10 studies (17 patients) were included. All patients achieved technical success. Majority studies reported use of plastic stents or naso-cystic drains whereas only 1 case reported use of metal stents. One procedure related complication (localized para-esophageal abscess) was reported requiring endoscopic intervention for management. EUS-guided drainage of caudate lobe abscess is safe and effective. It should be used as a first-line intervention after a failed medical management.

Hyper‐IgE syndrome presenting with early life craniosynostosis in monozygotic twin sisters

<scp>Hyper‐IgE</scp> syndrome presenting with early life craniosynostosis in monozygotic twin sisters

Risk Factors and Prognosis of Epilepsy Following Brain Abscess: A Nationwide Population-Based Cohort Study.

Epilepsy in patients with brain abscess is frequent, but risk factors and prognosis remain undetermined. This study examined risk factors of epilepsy among survivors of brain abscess and associated prognosis. Nationwide, population-based healthcare registries were used to compute cumulative incidences and cause-specific adjusted hazard rate ratios (adj. HRRs) with 95% CIs for epilepsy among 30-day survivors of brain abscess from 1982 through 2016. Data were enriched with clinical details by medical record review of patients hospitalized from 2007 through 2016. Adjusted mortality rate ratios (adj. MRRs) were examined using epilepsy as a time-dependent variable. The study included 1,179 30-day survivors of brain abscess among whom 323 (27%) developed new-onset epilepsy after a median of 0.76 years (interquartile range [IQR] 0.24-2.41). At admission for brain abscess, the median age was 46 years (IQR 32-59) in patients with epilepsy compared with 52 years (IQR 33-64) in those without epilepsy. The proportion of female individuals was similar in patients with and without epilepsy (37%). Adj. HRRs for epilepsy were 2.44 (95% CI 1.89-3.15) for aspiration or excision of brain abscess, 2.37 (1.56-3.60) for alcohol abuse, 1.75 (1.27-2.40) for previous neurosurgery or head trauma, 1.62 (1.17-2.25) for stroke, and 1.55 (1.04-2.32) for age group 20-39 years. Cumulative incidences were increased in patients with alcohol abuse (52% vs 31%), aspiration or excision of brain abscess (41% vs 20%), previous neurosurgery or head trauma (41% vs 31%), and stroke (46% vs 31%). Analysis using clinical details from medical record review of patients from 2007 through 2016 demonstrated adj. HRRs of 3.70 (2.24-6.13) for seizures at admission for brain abscess and 1.80 (1.04-3.11) for frontal lobe abscess. By contrast, adj. HRR was 0.42 (0.21-0.86) for occipital lobe abscess. Using the entire registry-based cohort, patients with epilepsy had an adj. MRR of 1.26 (1.01-1.57). Important risk factors of epilepsy were seizures during admission for brain abscess, neurosurgery, alcoholism, frontal lobe abscess, and stroke. Epilepsy was associated with an increased mortality. Antiepileptic treatment may be guided by individual risk profiles, and a specialized follow-up is highlighted by an increased mortality in survivors with epilepsy.

Rhinocerebral mucormycosis (RCM): To study the clinical spectrum and outcome of 61 cases of RCM managed at a tertiary care center in India.

Mucormycosis is a life-threatening infection of the paranasal sinuses and nasal cavities that can easily spread to the orbit and the brain. It is caused by fungi of the family Mucoraceae. We present a case series of 61 patients diagnosed and treated for rhinocerebral mucormycosis (RCM) at a single tertiary health care center. After obtaining ethical clearance, all patient files with a final diagnosis of RCM were thoroughly analyzed in departmental records and a master chart was prepared. The study evaluated the etiology, clinical spectrum, diagnosis, management, complications, and outcome at 3 months of RCM cases. About 93.4% of the RCM cases were diabetic and an equal number had a past history of COVID infection. About 85.2% had received steroids for the treatment of coronavirus disease 2019 infection. The most common presentation of RCM was temporal lobe abscess (25.7%) followed by frontal lobe abscess (16.6%). At 3 months post-diagnosis, mortality in our study was 42.6%. About 26.2 % of the RCM cases had no disease, 23% had a static disease, and 8.2% had progressive disease at the end of 3 months. We report the largest single-center case series of RCM, comprising 61 patients. This case series underscores the importance of the early diagnosis and prompt treatment for a better prognosis for this dreadful disease. The three pillars of treatment for RCM cases include reversal of the immunosuppressive state, administration of antifungal drugs, and extensive surgical debridement. In spite of all this, mortality remains high.

Successful Treatment of Acute Invasive Rhino-Orbito-Cerebral Mucormycosis Associated with COVID -19: Case Report and Literature Review

Background and Aim: Mortality associated with post-coronavirus disease 2019 (COVID-19) rhino-orbital cerebral mucormycosis (ROCM) is an evolving concern. Association of COVID-19, corticosteroid therapy, and uncontrolled diabetes mellitus (DM) are considered predisposing factors for ROCM. We present two cases of successful treatment leading to patient survival for post-COVID-19, stage 4c-ROCM. Case Presentation: Two middle-aged men with poorly controlled DM were referred to our hospital for post-COVID-19 ROCM. They had received intravenous antivirals and dexamethasone as treatment in a primary center. Both patients had unilateral oculofacial pain and swelling followed by acute visual loss, unilateral proptosis, facial palsy, and trigeminal hypoesthesia. A computed tomography scan revealed opacity and bony erosion of paranasal sinuses (PNS). Obtained specimens confirmed mucormycosis agent on histopathological examination. After the failure of conservative treatments, retrobulbar injections of liposomal-amphotericin B, PNS debridement, and orbital exenteration, both patients developed blurred consciousness owing to the extension of the infection into the intracranial cavity. Brain magnetic resonance imaging revealed a right frontal lobe abscess in case 1 and a left frontal sinus abscess and involvement in case 2. Both underwent transcranial debridement and resection of necrotic tissue and drainage of the abscess. At follow-up, the patients were in good condition, and the fungal cultures were negative for mucormycosis agents. Conclusion: ROCM may be a complication of COVID-19 in high-risk patients. Control of the patient’s underlying systemic condition and prompt treatment with antifungal agents, along with timely aggressive resection of cerebral abscess and necrotic paranasal tissues, are the mainstays of management for ROCM.

MANAGEMENT OF COVID ASSOCIATED ORBITAL MUCORMYCOSIS IN TERTIARY CARE HOSPITAL

Objectives: The aim of the study was to study epidemiological characteristics and management of orbital mucormycosis in cases of rhino-orbital mucormycosis in tertiary care hospital. Methods: It is a retrospective study of 258 patients presenting to KGH, Visakhapatnam, over a duration of 3 months from June to August 2021. After taking detailed history regarding symptoms of mucormycosis, visual acuity was noted, slit lamp examination was done and necessary investigations such as microbiology, pathology specimens were sent and analyzed, imaging done, and management done accordingly. Results: The majority of patients came with ENT-related symptoms were treated with endoscopic debridement, that is, 216 (84%), endoscopic debridement with orbital decompression of 23 (9%), transcutaneous retrobulbar amphotericin B of 21 (8%), orbital exenteration of 17 (6.5%), total and partial maxillectomy of 28 (10.8%), temporal lobe abscess drainage of 7 (2.7%), frontal lobe abscess drainage of (1.16%), frontal bone abscess drainage of 3 (1.16%), dural abscess drainage of 6 (2.3%), 15 (5.8) treated conservatively, and 30 (11.6%) death. Conclusion: COVID-19 infection in presence of glycemic dysregulation predisposes to development of Rhino-orbital-cerebral mucormycosis. Strict glycemic control and judicious use of corticosteroids might help in decrease incidence of mucormycosis cases. Most of the patients presents with ENT-related symptoms if not treated early may spread to orbit and intracranial sites. Early treatment during early presentation might help prevent spreading orbital extension and intracranial extension.

Lung abscess with metastatic brain abscess- A case report

Brain abscess can result from spread of infection from contiguous sites or from distant hematogenous spread. Hematogenous spread from a distant site as from the lungs is more common with cyanotic congenital heart disease and in patients with infective endocarditis. We report a case of hematogenous spread of brain abscess from lung in a patient who had no concurrent heart disease. Klebsiella pneumonia was isolated both from brain abscess and from lung abscess. A fifty years old lady with uncontrolled sugars presented with cough with expectoration and fever. Chest X ray showed cavity with fluid level on the right side and sputum culture showed Klebsiella pneumoniae. She was treated with sensitive antibiotics. During in hospital stay she developed headache and blurring of vision. CT brain showed a right parietal lobe abscess. She underwent decompression procedure and abscess from brain was drained which also revealed growth of Klebsiella pneumoniae. Her echo was normal. She was treated with sensitive antibiotics and had clinical improvement. While treating a case of lung abscess, clinicians should be aware of the possibility of metastatic spread and a high index of suspicion and a radiological imaging leads to early diagnosis and treatment.

S2812 Cholelithiasis Resulting in Partial Mirizzi Syndrome and Liver Abscess

Introduction: Mirizzi syndrome is defined as common hepatic duct (CHD) obstruction caused by extrinsic compression from an impacted stone in the cystic duct or gallbladder infundibulum. Failure to recognize it prior to cholecystectomy, can result in intraoperative bile duct injury and subsequently in significant morbidity. Patients present with one or more of the following: right upper quadrant pain, fever and jaundice; classically with elevated bilirubin and alkaline phosphatase. Case Description/Methods: A 67-year-old female presented with fever, right upper quadrant abdominal pain and emesis. Workup revealed leukocytosis, bilirubin 0.4 mg/dL (≤1.2), alkaline phosphatase 226 IU/L (35-104), aspartate aminotransferase 42 IU/L (< 32) and alanine transferase 86 IU/L (< 33). CT scan followed by magnetic resonance cholangiopancreatography showed a 7.2 x 6.1 cm heterogenous lesion in the right hepatic lobe of the liver consistent with a liver abscess, contracted gallbladder with cholelithiasis, and a large gallbladder neck/cystic duct stone externally compressing the right hepatic duct causing upstream dilatation resulting in a partial Mirizzi syndrome (Figure A). The left hepatic duct, CHD, and common bile duct (CBD) were unaffected. Endoscopic retrograde cholangiopancreatography (ERCP) confirmed a large gallbladder neck stone compressing the right hepatic duct, with a normal left hepatic duct, CHD, and CBD (Figure B). Biliary sphincterotomy with basket sweep of the CBD and stent placement was performed. Follow up cholangiogram revealed a decompressed biliary tree. The liver abscess was drained percutaneously, and patient was discharged on intravenous antibiotics. She underwent elective cholecystectomy with right hepaticojejunostomy after 8 weeks. Postoperative imaging showed intact hepaticojejunostomy and no residual abscess. Discussion: This case is unique as patient did not develop classic obstructive jaundice due to intact drainage on the left but developed a liver abscess due to prolonged biliary stasis on the right. The patient required a combined endoscopic, interventional, and surgical approach for therapeutic success. Recognition of Mirizzi syndrome was key to planning therapeutic steps with ERCP followed by abscess drainage prior to surgery to ensure the best possible outcome for the patient.Figure 1.: A: MRCP showing right liver lobe abscess (white arrow). B: ERCP showing gallbladder (black arrow) with stone in gallbladder neck (block arrow) causing compression and upstream intrahepatic dilatation of right intrahepatic duct (white arrow). MRCP (magnetic resonance cholangiopancreatography), ERCP (endoscopic retrograde cholangiopancreatography).

BILIPTYSIS: BRONCHOBILIARY FISTULA (BBF) RESULTING FROM RIGHT LOWER LUNG ABSCESS

BILIPTYSIS: BRONCHOBILIARY FISTULA (BBF) RESULTING FROM RIGHT LOWER LUNG ABSCESS

A Rare Case of Occipital Subdural Abscess of Rhinogenic Origin: Case Report.

In the present day scenario complications arising from sinusitis are rare, since the introduction of antibiotics. However Sinusitis and its complications are still existing and masking of symptoms due to inadequate dosage and duration of antibiotics, which is life threatening and if neglected may result in high morbidity and mortality. This case has been presented for its rare presentation of parafalcine abscess of left occipital lobe of middle cranial fossa, which is secondary to frontal sinusitis. A 40year old male patient was admitted in ICU with chief complaints of fever for 3days, headache and neck stiffness for 2days and altered sensorium for 1day. Computed tomography showed both frontals, ethmoids and maxillary sinusitis on the left side. Patient was given conservative treatment and showed partial improvement of symptoms. On repeat CT brain (after 2weeks) showed abscess parasagittally in left occipital lobe. Neurosurgeon aspirated abscess through parasagittal approach. Later the patient referred to the ENT department and ESS (endoscopic sinus surgery) DRAF II procedure done for clearance of frontal sinus to avoid recurrence of intracranial complications.

P256 A rare case of co-infection with Nigrospora oryzae with mucormycosis in an immunocompromised post-COVID patient

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PMObjectiveA rare case of co-infection of Nigrospora oryzae with mucormycosis in an immunocompromised post-COVID patient.MethodsA 41-year-old male diabetic patient, with sub-optimal glycemic control, contracted COVID-19 infection and was managed with high-dose steroids. A month after recovery from COVID-19 infection, he developed severe headache with sudden onset right-sided facial swelling. A contrast-enhanced magnetic resonance imaging was done which was suggestive of infective/inflammatory rhinosinusitis with intracranial extension with a possibility of fungal etiology. Functional endoscopic sinus surgery was performed and tissue was sent for microbiological processing. On KOH mount, broad pauciseptate fungal hyphae were seen. Fungal growth was obtained on SDA at 25°C and 37°C within 4 days of inoculation. It was confirmed as Rhizopus arrhizus both phenotypically as well as by MALDI-TOF. Patient was put on antifungal therapy in form of Inj liposomal Amphotericin B 500 mg/d. However, patient had persistent headache, vomiting, and low-grade fever post-procedure. A repeat CE-MRI was performed which was suggestive of necrotic brain tumor/abscess and was planned for frontal lobe abscess drainage. Pus was inoculated on routine mycological media. On KOH mount, broad pauciseptate hyphae along with narrow septate hyphae were seen. Fungal growth was obtained on SDA at 25°C within 5 days of inoculation, which on LPCB were identified as Nigrospora spp. The identity of the isolate was confirmed by Next generation sequencing as Nigrospora oryzae. Post-2 weeks of treatment and strict glycemic control, patient started improving. The headache and swelling subsided. He was further started on oral hypoglycemic agents and discharged and was asked to follow up after a month.ResultsCOVID-19 epidemic that emerged by the end of 2019 has been associated with a huge number of deaths globally. Acute invasive fungal rhino-sinusitis is a potentially fatal infection in immune-compromised patients post COVID-19. Various studies reveal that invasive fungal infections have been the leading cause of death in 25%-73.7% of patients. Among these invasive fungal infections, Mucor spp. were detected in 77.8% patient, Aspergillus fumigatus in 30.6% while 8.3% showed mixed infection with both the fungi. Along with the established pathogenicity of Mucorales in causing invasive fungal infection, other fungal co-infections are also being observed. These invasive fungal infections in an immune-compromised host carry a high mortality and morbidity rate (18%-80%). Therefore, early diagnosis, followed by aggressive medical care, surgical debridement, and control of underlying diseases is of utmost importance.ConclusionAcute invasive fungal rhinosinusitis saw a spurt in incidence during the widespread COVID-19 pandemic.Diagnosis of invasive fungal infection is based on the clinical setting and characteristic presentation, supported by radiological and microbiological evidence. Prompt diagnosis and treatment are the need of the hour.