Garg Deepak, Muthu Valliappan, Sehgal Inderpaul Singh, Ramachandran Raja, Kaur Harsimran, Bhalla Ashish, Puri Goverdhan D, Chakrabarti Arunaloke, Agarwal Ritesh
Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Sector-12, Chandigarh, 160012, India.
Department of Nephrology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Mycopathologia. 2021 May;186(2):289-298. doi: 10.1007/s11046-021-00528-2. Epub 2021 Feb 5.
Severe coronavirus disease (COVID-19) is currently managed with systemic glucocorticoids. Opportunistic fungal infections are of concern in such patients. While COVID-19 associated pulmonary aspergillosis is increasingly recognized, mucormycosis is rare. We describe a case of probable pulmonary mucormycosis in a 55-year-old man with diabetes, end-stage kidney disease, and COVID-19. The index case was diagnosed with pulmonary mucormycosis 21 days following admission for severe COVID-19. He received 5 g of liposomal amphotericin B and was discharged after 54 days from the hospital. We also performed a systematic review of the literature and identified seven additional cases of COVID-19 associated mucormycosis (CAM). Of the eight cases included in our review, diabetes mellitus was the most common risk factor. Three subjects had no risk factor other than glucocorticoids for COVID-19. Mucormycosis usually developed 10-14 days after hospitalization. All except the index case died. In two subjects, CAM was diagnosed postmortem. Mucormycosis is an uncommon but serious infection that complicates the course of severe COVID-19. Subjects with diabetes mellitus and multiple risk factors may be at a higher risk for developing mucormycosis. Concurrent glucocorticoid therapy probably heightens the risk of mucormycosis. A high index of suspicion and aggressive management is required to improve outcomes.
目前，重症冠状病毒病（COVID-19）采用全身性糖皮质激素进行治疗。此类患者易发生机会性真菌感染。虽然与COVID-19相关的肺曲霉病越来越受到关注，但毛霉病较为罕见。我们描述了一例55岁男性患者，患有糖尿病、终末期肾病和COVID-19，可能患有肺毛霉病。该病例在因重症COVID-19入院21天后被诊断为肺毛霉病。他接受了5克脂质体两性霉素B治疗，并在入院54天后出院。我们还对文献进行了系统回顾，确定了另外7例与COVID-19相关的毛霉病（CAM）病例。在我们回顾的8例病例中，糖尿病是最常见的危险因素。3名受试者除糖皮质激素外无其他COVID-19危险因素。毛霉病通常在住院10 - 14天后发生。除索引病例外，所有患者均死亡。在2名受试者中，CAM是在死后诊断的。毛霉病是一种罕见但严重的感染并发症，会使重症COVID-19的病程复杂化。患有糖尿病和多种危险因素的受试者发生毛霉病的风险可能更高。同时使用糖皮质激素治疗可能会增加毛霉病的风险。需要高度怀疑并积极治疗以改善预后。
