Department of Diabetes & Endocrinology, G. D Hospital & Diabetes Institute, Kolkata, West Bengal, India.
Department of Diabetes & Endocrinology, G. D Hospital & Diabetes Institute, Kolkata, West Bengal, India.
Diabetes Metab Syndr. 2021 Jul-Aug;15(4):102146. doi: 10.1016/j.dsx.2021.05.019. Epub 2021 May 21.
BACKGROUND AND AIMS: There are increasing case reports of rhino-orbital mucormycosis in people with coronavirus disease 2019 (COVID-19), especially from India. Diabetes mellitus (DM) is an independent risk factor for both severe COVID-19 and mucormycosis. We aim to conduct a systematic review of literature to find out the patient's characteristics having mucormycosis and COVID-19. METHODS: We searched the electronic database of PubMed and Google Scholar from inception until May 13, 2021 using keywords. We retrieved all the granular details of case reports/series of patients with mucormycosis, and COVID-19 reported world-wide. Subsequently we analyzed the patient characteristics, associated comorbidities, location of mucormycosis, use of steroids and its outcome in people with COVID-19. RESULTS: Overall, 101 cases of mucormycosis in people with COVID-19 have been reported, of which 82 cases were from India and 19 from the rest of the world. Mucormycosis was predominantly seen in males (78.9%), both in people who were active (59.4%) or recovered (40.6%) from COVID-19. Pre-existing diabetes mellitus (DM) was present in 80% of cases, while concomitant diabetic ketoacidosis (DKA) was present in 14.9%. Corticosteroid intake for the treatment of COVID-19 was recorded in 76.3% of cases. Mucormycosis involving nose and sinuses (88.9%) was most common followed by rhino-orbital (56.7%). Mortality was noted in 30.7% of the cases. CONCLUSION: An unholy trinity of diabetes, rampant use of corticosteroid in a background of COVID-19 appears to increase mucormycosis. All efforts should be made to maintain optimal glucose and only judicious use of corticosteroids in patients with COVID-19.
背景与目的:越来越多的报道称,2019 年冠状病毒病(COVID-19)患者中出现了鼻-眶-脑毛霉菌病(rhino-orbital mucormycosis,ROM),尤其是来自印度的报道。糖尿病(diabetes mellitus,DM)是 COVID-19 重症和毛霉菌病的独立危险因素。我们旨在进行系统评价文献,以发现患有毛霉菌病和 COVID-19 的患者特征。
方法:我们使用关键词从电子数据库 PubMed 和 Google Scholar 中检索了截至 2021 年 5 月 13 日的文献。我们检索了全球范围内报道的所有患有毛霉菌病和 COVID-19 的病例报告/病例系列的详细资料。随后,我们分析了 COVID-19 患者中毛霉菌病的患者特征、相关合并症、毛霉菌病的部位、皮质类固醇的使用及其结局。
结果:总体而言,报道了 101 例 COVID-19 患者并发毛霉菌病,其中 82 例来自印度,19 例来自世界其他地区。毛霉菌病主要发生在男性(78.9%)中,这些患者或为 COVID-19 活动期(59.4%),或为恢复期(40.6%)。80%的病例存在糖尿病,同时伴有糖尿病酮症酸中毒(diabetic ketoacidosis,DKA)的占 14.9%。记录了 76.3%的病例使用皮质类固醇治疗 COVID-19。最常见的是鼻和鼻窦受累(88.9%),其次是鼻-眶(56.7%)。30.7%的病例死亡。
结论:糖尿病、COVID-19 背景下大剂量使用皮质类固醇的“三因素致病组合”似乎增加了毛霉菌病的发生风险。应尽力保持血糖最佳,仅在 COVID-19 患者中谨慎使用皮质类固醇。
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