Mucor in a Viral Land: A Tale of Two Pathogens.
Mucor in a Viral Land: A Tale of Two Pathogens.
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DOI：
10.4103/ijo.ijo_3774_20
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发表时间：
2021-03
影响因子：
3.1
通讯作者：
Honavar SG
中科院分区：
文献类型：
--
作者：
Sen M;Lahane S;Lahane TP;Parekh R;Honavar SG
COVID-19 感染、其治疗、由此产生的免疫抑制以及先前存在的合并症使患者容易受到包括毛霉菌病在内的继发感染。了解症状、时间顺序、危险因素和结果对于采取预防和治疗措施非常重要。我们对 2020 年 8 月 1 日至 12 月 15 日期间在印度两个三级眼科转诊中心接受治疗的连续 6 名患有鼻眼眶毛霉菌病的 COVID-19 患者进行了回顾性介入研究。毛霉菌病的诊断基于鼻窦活检的临床特征、培养和组织病理学。患者接受静脉注射两性霉素 B 脂质体加泊沙康唑和手术清创坏死组织进行治疗。所有患者均为男性，平均年龄 60.5 ± 12 (46.2–73.9) 岁，2 型糖尿病患者，平均血糖水平为 222.5 ± 144.4 (86–404) mg/dL。除一名患者与COVID-19同时被诊断为毛霉菌病外，所有患者均接受全身皮质类固醇治疗COVID-19。从诊断出 COVID-19 到出现毛霉症状之间的平均持续时间为 15.6 ± 9.6 (3–42) 天。所有患者均接受内窥镜鼻窦清创术，其中两名患者需要进行眼眶切除术。在最后一次随访中，所有六名患者都活着，正在接受抗真菌治疗。毛霉菌病是一种危及生命的机会性感染，患有中度至重度 COVID-19 的患者更容易受到感染。不受控制的糖尿病和使用皮质类固醇会增加毛霉菌病侵袭性真菌感染的风险，毛霉菌病可能在病程中发生或作为后遗症发生。高度怀疑、早期诊断和适当的管理可以提高生存率。
COVID-19 infection, its treatment, resultant immunosuppression, and pre-existing comorbidities have made patients vulnerable to secondary infections including mucormycosis. It is important to understand the presentation, temporal sequence, risk factors, and outcomes to undertake measures for prevention and treatment. We conducted a retrospective, interventional study on six consecutive patients with COVID-19 who developed rhino-orbital mucormycosis and were managed at two tertiary ophthalmic referral centers in India between August 1 and December 15, 2020. Diagnosis of mucormycosis was based on clinical features, culture, and histopathology from sinus biopsy. Patients were treated with intravenous liposomal amphotericin B with addition of posaconazole and surgical debridement of necrotic tissue. All patients were male, mean age 60.5 ± 12 (46.2–73.9) years, type 2 diabetics with mean blood glucose level of 222.5 ± 144.4 (86–404) mg/dL. Except for one patient who was diagnosed with mucormycosis concurrently with COVID-19, all patients received systemic corticosteroids for the treatment of COVID-19. The mean duration between diagnosis of COVID-19 and development of symptoms of mucor was 15.6 ± 9.6 (3–42) days. All patients underwent endoscopic sinus debridement, whereas two patients required orbital exenteration. At the last follow-up, all six patients were alive, on antifungal therapy. Mucormycosis is a life-threatening, opportunistic infection, and patients with moderate to severe COVID-19 are more susceptible to it. Uncontrolled diabetes mellitus and use of corticosteroids increase the risk of invasive fungal infection with mucormycosis which can develop during the course of the illness or as a sequelae. High index of suspicion, early diagnosis, and appropriate management can improve survival.