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新冠疫情时代鼻-眶-脑型毛霉病的管理挑战:一项前瞻性观察研究

Management Challenge of Rhino-Orbito-Cerebral Mucormycosis in Covid 19 Era: A Prospective Observational Study.

作者信息

Pippal Sunil Kumar, Kumar Dinesh, Ukawat Lavi

机构信息

Department of E.N.T., Bundelkhand Medical College, Sagar, M.P India.

出版信息

Indian J Otolaryngol Head Neck Surg. 2022 Oct;74(Suppl 2):3485-3491. doi: 10.1007/s12070-021-02947-5. Epub 2021 Oct 23.

Abstract

Mucormycosis is an uncommon but a fatal fungal infection that usually affects patients with altered immunity. The Rhizopus Oryzae is most common type and responsible for nearly 60% of mucormycosis cases in humans and also accounts for 90% of the Rhino-orbital-cerebral (ROCM) form. Our aim and objective was to study, the site of mucormycosis in nose and paranasal sinuses, adjacent site like orbit palate or intracranial involvement, co-morbid condition and management to be done in confirm mucormycosis patients. The most common sinuses involved are the ethmoid, maxillary followed by the frontal and sphenoid sinus. Diabetes mellitus is often associated with mucormycosis of the paranasal sinuses, as is corona virus infection; uncontrolled diabetes further increases the risk. Intra-orbital involvement is common, but intracranial involvement is rare. Extensive steroid and broad-spectrum antibiotic use for Covid-19 management may cause or exacerbate fungal disease. All the patients required surgical intervention along with medical treatment.

摘要

毛霉菌病是一种罕见但致命的真菌感染,通常影响免疫力改变的患者。米根霉是最常见的类型,导致近60%的人类毛霉菌病病例,也是90%鼻眶脑型(ROCM)的病因。我们的目的是研究毛霉菌病在鼻腔和鼻窦的发病部位、眼眶、腭部等相邻部位或颅内受累情况、合并病症以及确诊为毛霉菌病患者的治疗方法。最常受累的鼻窦是筛窦、上颌窦,其次是额窦和蝶窦。糖尿病常与鼻窦毛霉菌病相关,冠状病毒感染也是如此;未控制的糖尿病会进一步增加风险。眶内受累很常见,但颅内受累很少见。用于新冠肺炎治疗的大量类固醇和广谱抗生素的使用可能会导致或加重真菌疾病。所有患者都需要手术干预和药物治疗。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9201/9702448/0cda2e92b0cc/12070_2021_2947_Fig1_HTML.jpg

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