Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany.
Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany.
Mycoses. 2022 Jan;65(1):103-109. doi: 10.1111/myc.13379. Epub 2021 Nov 16.
Most COVID-19-associated mucormycosis (CAM) cases are reported from India and neighbouring countries. Anecdotally cases from Europe have been presented.
To estimate the disease burden and describe the clinical presentation of CAM in Germany.
We identified cases through German mycology networks and scientific societies, and collected anonymised clinical information via FungiScope®.
We identified 13 CAM cases from six tertiary referral hospitals diagnosed between March 2020 and June 2021. Twelve patients had severe or critical COVID-19, eleven were mechanically ventilated for a median of 8 days (range 1-27 days) before diagnosis of CAM. Eleven patients received systemic corticosteroids. Additional underlying medical conditions were reported for all but one patient, five were immunocompromised because of malignancy or organ transplantation, three were diabetic. Eleven patients developed pneumonia. Mortality was 53.8% with a median time from diagnosis of mucormycosis to death of 9 days (range 0-214 days) despite treatment with liposomal amphotericin B and/or isavuconazole in 10 of 13 cases. CAM prevalence amongst hospitalised COVID-19 patients overall (0.67% and 0.58% in two centres) and those admitted to the intensive care unit (ICU) (1.47%, 1.78% and 0.15% in three centres) was significantly higher compared to non-COVID-19 patients (P < .001 for respective comparisons).
COVID-19-associated mucormycosis is rare in Germany, mostly reported in patients with comorbidities and impaired immune system and severe COVID-19 treated in the ICU with high mortality compared to mainly rhino-orbito-cerebral CAM in patients with mild COVID-19 in India. Risk for CAM is higher in hospitalised COVID-19 patients than in other patients.
大多数 COVID-19 相关毛霉菌病（CAM）病例报告来自印度和周边国家。据报道，欧洲也有病例。
估计德国 CAM 的疾病负担并描述其临床特征。
我们通过德国真菌学网络和科学协会确定病例，并通过 FungiScope®收集匿名临床信息。
我们从六家三级转诊医院中确定了 13 例 CAM 病例，这些病例的诊断时间为 2020 年 3 月至 2021 年 6 月之间。12 名患者患有严重或危重症 COVID-19，在诊断为 CAM 之前，11 名患者接受机械通气，中位数为 8 天（范围 1-27 天）。11 名患者接受了全身皮质类固醇治疗。除 1 名患者外，其他患者均有其他基础疾病，5 名患者因恶性肿瘤或器官移植而免疫功能低下，3 名患者患有糖尿病。11 名患者发生肺炎。尽管 13 例中有 10 例接受了脂质体两性霉素 B 和/或伊曲康唑治疗，但死亡率仍为 53.8%，从毛霉菌病诊断到死亡的中位数时间为 9 天（范围 0-214 天）。与非 COVID-19 患者相比，CAM 在住院 COVID-19 患者中的总体患病率（在两个中心分别为 0.67%和 0.58%）和 ICU 入院患者中的患病率（在三个中心分别为 1.47%、1.78%和 0.15%）显著更高（分别与各自的比较相比，P<.001）。
COVID-19 相关毛霉菌病在德国很少见，主要发生在合并症和免疫系统受损的患者中，与印度 COVID-19 轻症患者中主要为鼻-眶-脑 CAM 相比，在 ICU 接受高死亡率治疗的 COVID-19 患者死亡率更高。与其他患者相比，COVID-19 住院患者发生 CAM 的风险更高。
