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新型冠状病毒肺炎炎症标志物在鼻眶脑型毛霉病中的作用:指定节点中心易感患者的病例研究

Role of COVID 19 Inflammatory Markers in Rhino-Orbito-Cerebral Mucormycosis: A Case Study in Predisposed Patients at a Designated Nodal Centre.

作者信息

Goddanti Nitya, Reddy Y Mounika, Kumar M Kiran, Rajesh M, Reddy L Sudarshan

机构信息

Government ENT Hospital, Koti, Hyderabad, Telangana India.

出版信息

Indian J Otolaryngol Head Neck Surg. 2022 Oct;74(Suppl 2):3498-3504. doi: 10.1007/s12070-021-02970-6. Epub 2021 Nov 13.

Abstract

Mucormycosis is a very morbid and potentially life threatening fungal infection. Sudden emergence and rapidly increasing numbers, of an otherwise rare infection in active Corona virus disease 2019 (COVID-19) or recently recovered patients has made us question the cause for this epidemic in India. This retrospective cohort study was done at Government Ear, Nose and Throat (ENT) hospital, Hyderabad, a designated nodal centre for mucormycosis for the state of Telangana, between April 2021 and June 2021. This study included patients with mucormycosis who had a recent history of COVID-19 infection. Potential predisposing factors (diabetes mellitus, history of oxygen and corticosteroids usage) and inflammatory marker values, predominantly deranged in COVID-19 infection (D-dimer and Serum Ferritin) were evaluated. A correlation between the marker values and susceptibility factors was also studied. Majority of these subjects showed elevated serum markers and had one or more of the predisposing factors for COVID-19 associated mucormycosis (CAM). A significant association was found between elevated marker values and susceptibility factors (diabetes, use of oxygen). Contrary to the popular belief, that the inadvertent use of steroids, use of industrial oxygen or elevated blood sugars caused this epidemic, our study concludes that their role is limited to affecting the extent of morbidity/mortality. B.1.1.7 and B.6.117 variants of severe acute respiratory syndrome coronavirus 2 (SARSCoV2), predominant during the second wave in India, facilitated the fungal invasion and spread by altering the gene expression and inducing inflammatory and immunomodulatory changes.

摘要

毛霉病是一种非常严重且可能危及生命的真菌感染。在新型冠状病毒肺炎(COVID-19)患者或近期康复患者中,这种原本罕见的感染突然出现且数量迅速增加,这让我们对印度此次疫情的原因产生了疑问。这项回顾性队列研究于2021年4月至2021年6月在海得拉巴政府耳鼻喉(ENT)医院进行,该医院是特伦甘纳邦毛霉病指定的节点中心。本研究纳入了近期有COVID-19感染病史的毛霉病患者。评估了潜在的诱发因素(糖尿病、吸氧史和使用皮质类固醇史)以及在COVID-19感染中主要紊乱的炎症标志物值(D-二聚体和血清铁蛋白)。还研究了标志物值与易感因素之间的相关性。这些受试者中的大多数血清标志物升高,并且有一个或多个与COVID-19相关的毛霉病(CAM)的诱发因素。在升高 的标志物值与易感因素(糖尿病、吸氧)之间发现了显著关联。与普遍认为的无意中使用类固醇、使用工业氧气或血糖升高导致此次疫情不同,我们的研究得出结论,它们的作用仅限于影响发病/死亡的程度。严重急性呼吸综合征冠状病毒2(SARS-CoV-2)的B.1.1.7和B.6.117变异株在印度第二波疫情期间占主导地位,通过改变基因表达以及诱导炎症和免疫调节变化促进了真菌的侵袭和传播。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4c1e/9702275/becc55c808e4/12070_2021_2970_Fig1_HTML.jpg

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