Dr ABM Kamrul Hasan, Assistant Professor & Head, Department of Endocrinology, Mymensingh Medical College, Mymensingh, Bangladesh; E-mail:
Mymensingh Med J. 2021 Jul;30(3):874-880.
Recently, mucormycosis, extremely rare fungal infections are emerging as a matter of concern in COVID-19. The saprophytic fungi of Mucorales species cause the disease, Mucormycosis, only in immunocompromised hosts. Clinical presentation of mucormycosis is related to the underlying conditions; rhino-cerebral disease is the most common form, especially in patients with diabetes mellitus; pulmonary, cutaneous, or gastrointestinal infections can also occur. Severe COVID-19 itself is a life-threatening disease and various factors, including diabetes, especially when complicated by ketoacidosis, previous respiratory pathology, immunosuppressive therapy, nosocomial infection sources and systemic immune alterations of COVID-19 itself predispose to mucormycosis. No specific biomarkers are available to diagnose mucormycosis; imaging of the involved area and histopathological examination of the biopsied tissue are most important in diagnosis. The underlying medical conditions must be corrected; these include good glycemic control, tapering of steroids, and reducing or stopping immunosuppressive medications. Systemic antifungal therapy with liposomal Amphotericin B is the medical treatment of choice though drug resistance is not uncommon. Surgical debridement of devitalized tissue is often required. Severe COVID-19 patients with secondary co-infections require longer hospitalization and had higher risks of death. The mortality rate is almost 50% despite timely adequate treatment. The judicious use of systemic glucocorticoids and immunosuppressive agents for treating severe disease and hyperglycemia control seems vital for preventing and managing mucormycosis.
最近，极为罕见的真菌感染——毛霉病，在 COVID-19 中成为一个令人关注的问题。毛霉目真菌中的腐生物引起毛霉病，仅在免疫功能低下的宿主中发生。毛霉病的临床表现与基础疾病有关；鼻-脑疾病是最常见的形式，特别是在糖尿病患者中；也可能发生肺部、皮肤或胃肠道感染。严重的 COVID-19 本身就是一种危及生命的疾病，各种因素，包括糖尿病，尤其是伴有酮症酸中毒时、先前的呼吸道病理学、免疫抑制治疗、医院感染源和 COVID-19 本身的全身免疫改变，都容易导致毛霉病。目前尚无用于诊断毛霉病的特异性生物标志物；受影响区域的影像学和活检组织的组织病理学检查对诊断最重要。必须纠正基础医疗条件；这包括良好的血糖控制、类固醇的减量以及减少或停止免疫抑制药物。全身性抗真菌治疗使用脂质体两性霉素 B 是首选的治疗方法，尽管耐药性并不少见。通常需要对坏死组织进行外科清创。继发合并感染的严重 COVID-19 患者需要更长时间的住院治疗，并且死亡风险更高。尽管及时进行了充分的治疗，死亡率仍接近 50%。明智地使用全身性糖皮质激素和免疫抑制剂治疗严重疾病和控制高血糖对于预防和管理毛霉病似乎至关重要。
