Singh Yudhyavir, Ganesh Venkata, Kumar Shailendra, Patel Nishant, Aggarwala Richa, Soni Kapil Dev, Trikha Anjan
Anaesthesiology, Critical Care and Pain Medicine, All India Institute of Medical Sciences, New Delhi, New Delhi, IND.
Critical and Intensive Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, New Delhi, IND.
Cureus. 2021 Jul 3;13(7):e16152. doi: 10.7759/cureus.16152. eCollection 2021 Jul.
Coronavirus disease (COVID-19) remains a health concern with new challenges emerging as the pandemic progresses. The recent rise of opportunistic infections especially mucormycosis in COVID-19 patients is further complicating their outcomes. Mucormycosis is well known to infect patients with diabetes mellitus, malignancy, chemotherapy, and other immunocompromised conditions. The treatment of COVID-19 largely remains systemic steroids and other immunomodulators that add to the risk of invasive fungal infection.
Here, we present a retrospective case series of 13 patients with individual clinical characteristics along with the demography and treatment details. The data were collected retrospectively in a single center that caters to a large population of COVID-19 patients with varying severity.
Thirteen patients were presented with COVID-19 associated mucormycosis (CAM). The median age was higher in non-survivors (49.5 years), with a higher odds of death (23.8) in those with severe COVID, having overall mortality of 64.3%. Moreover, diabetes mellitus was present in 61.5% of patients with a mortality of 75%. About 11 (84.6%) patients had received prior steroids for COVID-19. The incidence of hyperglycemia at admission was equal among both survivors and non-survivors.
The prevalence of mucormycosis seems to be increasing among COVID-19 patients which may be associated with increased use of steroids, the possible immunocompromised state imposed by SARS-CoV-2, or co-existing conditions such as diabetes mellitus. The mortality of CAM is remarkably high and apart from preventive practices and rational use of immunomodulators, a high index of suspicion with early diagnosis would be key to survival.
随着新冠疫情的发展，新冠病毒病（COVID-19）仍是一个令人担忧的健康问题，新的挑战不断涌现。近期，COVID-19患者中机会性感染尤其是毛霉菌病的增多，使他们的病情结果更加复杂。众所周知，毛霉菌病会感染糖尿病、恶性肿瘤、化疗及其他免疫功能低下的患者。COVID-19的治疗主要仍为全身使用类固醇和其他免疫调节剂，这增加了侵袭性真菌感染的风险。
在此，我们呈现了一个回顾性病例系列，包含13例患者的个体临床特征、人口统计学信息及治疗细节。数据是在一个为大量不同严重程度的COVID-19患者提供服务的单一中心进行回顾性收集的。
13例患者被诊断为COVID-19相关毛霉菌病（CAM）。非幸存者的中位年龄较高（49.5岁），重症COVID患者的死亡几率更高（23.8），总体死亡率为64.3%。此外，61.5%的患者患有糖尿病，死亡率为75%。约11例（84.6%）患者曾因COVID-19接受过类固醇治疗。幸存者和非幸存者入院时高血糖的发生率相同。
毛霉菌病在COVID-19患者中的患病率似乎在上升，这可能与类固醇使用增加、SARS-CoV-2导致的可能免疫功能低下状态或糖尿病等并存疾病有关。CAM的死亡率非常高，除了预防措施和合理使用免疫调节剂外，高度的怀疑指数和早期诊断是生存的关键。
