Three people in the North have jawbone necrosis, two deaths

HanoiBach Mai Hospital received three cases of osteonecrosis of the maxillofacial bone due to black fungus Mucormycosis, of which two died, one was being actively treated.

“Two patients who died had a history of Covid-19, diabetes, severe bone necrosis,” Associate Professor Do Duy Cuong, Director of the Center for Tropical Diseases, Bach Mai Hospital, shared at the hospital. National Parasitology Conferencerecently.

The first case is a 64-year-old man, living in Nam Dinh, with a history of diabetes, hospitalized because of facial swelling, right eye near loss of vision, left molar pain. More than three weeks before being hospitalized, he contracted Covid-19 and was self-monitoring at home.

The doctors diagnosed acute sinusitis, suspected abscess, and surgically recorded black necrosis of the mucosa of the maxillary sinus, the alar, and the anterior covering of the cheekbones. Pathology revealed that the patient had a black fungus Mucormycosis, which required antifungal medication.

After more than a month of treatment, the level of necrosis increased, and had to undergo maxillofacial surgery. The patient fell into exhaustion, septic shock, and later death.

The second case, a 59-year-old man, from Ha Tinh, transferred to Bach Mai Hospital at the end of March. The patient had hypertension and diabetes before but did not receive treatment.

15 days before being admitted to the hospital, he had pain and swelling in the left side of his face and had to have his teeth extracted. A day later, he contracted Covid-19, self-monitoring at home. The patient continued to have facial pain, swelling, fever, headache, and difficulty breathing. In the local hospital, the patient was lethargic, CT-Scan of the skull showed an intracranial gas accumulation, damage to the temporal lobe.

When transferred to Bach Mai Hospital, the patient’s entire face was swollen, spreading to the neck area, the left eye was swollen, oozing pus, the pupil was dilated, almost blind. Cranial MRI recorded patients with cerebral infarction, middle cerebral artery occlusion, complicated polysinusitis, meningitis.

The doctor treated in the direction of sepsis, using broad-spectrum antibiotics, then emergency surgery to remove the necrosis, remove the tooth abscess, open the skull to reduce pressure. The hospital identified a patient infected with Mucormycosis, treated actively but still in a deep coma, brain damage. The family asked to return and the patient later died.

The third case is a 72-year-old woman, living in Hanoi, hospitalized in mid-June due to toothache, pain in the eye socket, history of sinusitis, and uncontrolled diabetes. The patient has not recorded Covid-19 infection. The doctors performed emergency surgery, removed the necrotic part, the abscess and cultured the filamentous fungus, resulting in lesions caused by Mucormycosis. Patients treated with antibiotics, antifungal, are improving.

Mushroom Mucormycosis. Image: News-medical

According to Associate Professor Cuong, all three cases have Mucormycosis fungus that causes damage to the face and jaw, in people with diabetes, possibly after contracting Covid-19. Mucormycosis is a rare, serious fungal infection. Statistics in the world, the rate of this fungal infection ranges from 0.005 to 17 per million population. Patients with fungal infections after contracting Covid-19 accounted for 76%, after having uncontrolled diabetes 80%; Men account for more cases, with a mortality rate of about 31%.

India is a country with an infection rate 80 times higher than other countries, closely related to the risk factors of diabetes and corticosteroid use. After the Covid-19 epidemic, the country reported a series of black fungus infections in patients who had been infected with nCoV, usually 12-18 days after recovering from Covid-19. The mortality rate rises to more than 90% if the lesion invades the brain.

Fungi live in the environment such as soil, water, especially organic matter such as rotting vegetables and fruits, which can be inhaled by humans or penetrated through scratches on the skin. Mushrooms are easy to invade immunocompromised people, especially people with diabetes in the stage of complications, people who use a lot of corticosteroids, cancer patients…

In mid-July, more than 20 cases of craniofacial necrosis appeared at a number of hospitals in Ho Chi Minh City such as Central Dental, Ear, Nose and Throat, Cho Ray. The common point in them is that they have been infected with Covid-19, but it is not clear whether the disease is related to Covid-19 or not. Two of them died. Some of these cases are infected with Candida, Aspergilus fungi. Representatives of hospitals said that the number of cases increased abnormally, increasing the number of people with necrosis of the upper jaw, skull, and maxillofacial region.

The Ministry of Health then met with a professional council to assess the cases, determine that the disease of skull-and-face necrosis is not a strange disease, advising people not to panic. The council has not yet concluded whether Covid-19 is related to craniofacial necrosis disease.

Le Phuong


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