COVID-19-associated mucormycosis: Evidence-based critical review of an emerging infection burden during the pandemic's second wave in India.
COVID-19-associated mucormycosis: Evidence-based critical review of an emerging infection burden during the pandemic's second wave in India.
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DOI：
10.1371/journal.pntd.0009921
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发表时间：
2021-11
影响因子：
3.8
通讯作者：
Mathew ST
中科院分区：
文献类型：
--
作者：
Aranjani JM;Manuel A;Abdul Razack HI;Mathew ST
2019冠状病毒病（COVID-19）在2021年初的第二波疫情中，在印度造成了毁灭性的混乱。随着每日感染率惊人地上升，严重病例的数量急剧增加。该国卫生基础设施不足，对医院病床、药品、疫苗和氧气的需求过多。毛霉菌病是一种侵袭性真菌感染，给这种具有挑战性的情况增加了更多负担，COVID-19患者突然激增。鼻-眶-脑型是最常见的类型。特别是，其中约四分之三的人患有糖尿病作为易患合并症，并接受皮质类固醇治疗COVID-19。可能的机制可能涉及免疫和炎症过程。糖尿病与COVID-19诱导的全身免疫变化相结合时，往往会导致免疫力下降和继发感染的风险增加。由于关于这种致命机会性感染的全面数据是在大流行的背景下不断发展的，预防战略主要涉及管理高危群体的共病状况。推荐的治疗策略主要包括手术清创和使用两性霉素B和选择的唑类药物进行抗真菌治疗。已经出现了几个以印度为中心的临床指南，以正确诊断感染，描述临床表现，了解所涉及的发病机制，并跟踪疾病进程。Code Mucor是最全面的一种，它为鼻-眶-脑型提出了一个简单但可靠的分期系统。最近提出了一个分期系统，一个专门的登记处已经开始工作。在这篇评论中，我们广泛分析了印度COVID-19相关毛霉菌病的最新证据和指南。
Coronavirus Disease 2019 (COVID-19), during the second wave in early 2021, has caused devastating chaos in India. As daily infection rates rise alarmingly, the number of severe cases has increased dramatically. The country has encountered health infrastructure inadequacy and excessive demand for hospital beds, drugs, vaccines, and oxygen. Adding more burden to such a challenging situation, mucormycosis, an invasive fungal infection, has seen a sudden surge in patients with COVID-19. The rhino-orbital-cerebral form is the most common type observed. In particular, approximately three-fourths of them had diabetes as predisposing comorbidity and received corticosteroids to treat COVID-19. Possible mechanisms may involve immune and inflammatory processes. Diabetes, when coupled with COVID-19–induced systemic immune change, tends to cause decreased immunity and an increased risk of secondary infections. Since comprehensive data on this fatal opportunistic infection are evolving against the backdrop of a major pandemic, prevention strategies primarily involve managing comorbid conditions in high-risk groups. The recommended treatment strategies primarily included surgical debridement and antifungal therapy using Amphotericin B and selected azoles. Several India-centric clinical guidelines have emerged to rightly diagnose the infection, characterise the clinical presentation, understand the pathogenesis involved, and track the disease course. Code Mucor is the most comprehensive one, which proposes a simple but reliable staging system for the rhino-orbital-cerebral form. A staging system has recently been proposed, and a dedicated registry has been started. In this critical review, we extensively analyse recent evidence and guidance on COVID-19–associated mucormycosis in India.
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