Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India.
Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India.
Am J Otolaryngol. 2022 Jan-Feb;43(1):103220. doi: 10.1016/j.amjoto.2021.103220. Epub 2021 Sep 11.
It is an incontrovertible fact that the Rhino Orbital Cerebral Mucormycosis (ROCM) upsurge is being seen in the context of COVID-19 in India. Briefly presented is evidence that in patients with uncontrolled diabetes, a dysfunctional immune system due to SARS-COV-2 and injudicious use of corticosteroids may be largely responsible for this malady.
To find the possible impact of COVID 19 infection and various co-morbidities on occurrence of ROCM and demonstrate the outcome based on medical and surgical interventions.
Prospective longitudinal study included patients diagnosed with acute invasive fungal rhinosinusitis after a recent COVID-19 infection. Diagnostic nasal endoscopy (DNE) was performed on each patient and swabs were taken and sent for fungal KOH staining and microscopy. Medical management included Injection Liposomal Amphotericin B, Posaconazole and Voriconazole. Surgical treatment was restricted to patients with RT PCR negative results for COVID-19. Endoscopic, open, and combined approaches were utilized to eradicate infection. Follow-up for survived patients was maintained regularly for the first postoperative month.
Out of total 131 patients, 111 patients had prior history of SARS COVID 19 infection, confirmed with a positive RT-PCR report and the rest 20 patients had no such history. Steroids were received as a part of treatment in 67 patients infected with COVID 19. Among 131 patients, 124 recovered, 1 worsened and 6 died. Out of 101 known diabetics, 98 recovered and 3 had fatal outcomes. 7 patients with previous history of COVID infection did not have any evidence of Diabetes mellitus, steroid intake or any other comorbidity.
It can be concluded that ROCM upsurge seen in the context of COVID-19 in India was mainly seen in patients with uncontrolled diabetes, a dysfunctional immune system due to SARS-COV-2 infection and injudicious use of corticosteroids.
在印度，COVID-19 背景下不可否认的事实是 Rhino Orbital Cerebral Mucormycosis（ROCM）正在抬头。简要介绍的证据表明，在未控制的糖尿病患者中，由于 SARS-COV-2 导致的免疫系统功能障碍和皮质类固醇的不当使用可能是导致这种疾病的主要原因。
寻找 COVID-19 感染和各种合并症对 ROCM 发生的可能影响，并根据医疗和手术干预的结果进行演示。
前瞻性纵向研究纳入了最近 COVID-19 感染后诊断为急性侵袭性真菌性鼻-鼻窦炎的患者。对每位患者进行诊断性鼻内窥镜检查（DNE），并进行拭子取样，进行真菌 KOH 染色和显微镜检查。药物治疗包括注射用脂质体两性霉素 B、泊沙康唑和伏立康唑。手术治疗仅限于 COVID-19 RT-PCR 检测结果为阴性的患者。采用内镜、开放和联合方法根除感染。对存活患者进行术后第一个月的定期随访。
在总共 131 名患者中，111 名患者有 SARS COVID-19 感染的既往史，通过阳性 RT-PCR 报告证实，其余 20 名患者没有这种病史。在感染 COVID-19 的 67 名患者中，有 67 名患者接受了类固醇治疗。在 131 名患者中，124 名患者康复，1 名患者病情恶化，6 名患者死亡。在 101 名已知的糖尿病患者中，98 名患者康复，3 名患者死亡。7 名有 COVID 感染既往史的患者没有任何糖尿病、类固醇摄入或其他合并症的证据。
可以得出结论，印度 COVID-19 背景下 ROCM 的抬头主要发生在未控制的糖尿病患者、由于 SARS-COV-2 感染导致的免疫系统功能障碍和皮质类固醇的不当使用。
