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冠状病毒病大流行期间的毛霉菌病:一种不容错过的诊断。

Mucormycosis during Coronavirus Disease Pandemic: A Diagnosis we Cannot Afford to Miss.

作者信息

Arthanari Kaneesh Karthik, Annamalai Sivakumar, Thangavelu Arthiie, Palanivelu Chandrika, Suresh Gowtham, Anbuselvan Sambavi

机构信息

Department of Oral and Maxillofacial Surgery, JKK Nattraja Dental College, Namakkal, Tamil Nadu, India.

Department of Periodontics, JKK Nattraja Dental College, Namakkal, Tamil Nadu, India.

出版信息

J Pharm Bioallied Sci. 2021 Nov;13(Suppl 2):S1769-S1771. doi: 10.4103/jpbs.jpbs_444_21. Epub 2021 Nov 10.

DOI:10.4103/jpbs.jpbs_444_21
PMID:35018075
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8686934/
Abstract

Mucormycosis is a very aggressive, devastating opportunistic fungal infection commonly involving nasal, maxillary,orbital, and cerebral regions. In the second wave of the coronavirus disease 2019 (COVID-19) pandemic, a high frequency of mucormycosis infections has been seen because of the triad of COVID-19, systemic steroids, and preexisting diabetes mellitus. A patient might present with a simple mobile tooth/teeth with multiple gingival abscesses Necrotic bone could be seen in the palate. Blackish discoloration might be present in the oral mucosa. There might be extraoral swelling . If rhino-oculo cerebral mucormycosis is diagnosed, then there are two immediate treatment modalities to be followed. Both surgical and medical treatment are necessary. Surgical is thorough debridement of the necrotic tissue. To prevent the occurrence of mucormycosis, meticulous glycemic control and rational use of steroids and antibiotics for the shortest possible time with adequate attention toward the ventilators and tubing are necessary.

摘要

毛霉菌病是一种极具侵袭性、破坏性的机会性真菌感染,通常累及鼻腔、上颌、眼眶和脑部区域。在2019冠状病毒病(COVID-19)大流行的第二波中,由于COVID-19、全身用类固醇和既往糖尿病这三者的共同作用,毛霉菌病感染的发生率很高。患者可能表现为一颗或多颗活动的牙齿伴有多处牙龈脓肿,腭部可见坏死骨。口腔黏膜可能出现发黑变色。可能存在口外肿胀。如果诊断为鼻-眼-脑型毛霉菌病,那么有两种直接的治疗方式可供采用。手术和药物治疗都很必要。手术是对坏死组织进行彻底清创。为预防毛霉菌病的发生,必须严格控制血糖,尽可能短时间合理使用类固醇和抗生素,并充分注意呼吸机和管道。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/71eb/8686934/791b32398a95/JPBS-13-1769-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/71eb/8686934/b515f7260c61/JPBS-13-1769-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/71eb/8686934/791b32398a95/JPBS-13-1769-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/71eb/8686934/b515f7260c61/JPBS-13-1769-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/71eb/8686934/791b32398a95/JPBS-13-1769-g002.jpg

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本文引用的文献

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When Uncontrolled Diabetes Mellitus and Severe COVID-19 Converge: The Perfect Storm for Mucormycosis.当未控制的糖尿病与重症 COVID-19 相遇:毛霉菌病的完美风暴。
J Fungi (Basel). 2021 Apr 15;7(4):298. doi: 10.3390/jof7040298.
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New-Onset Diabetes in Covid-19.新冠病毒感染引发的新发糖尿病
N Engl J Med. 2020 Aug 20;383(8):789-790. doi: 10.1056/NEJMc2018688. Epub 2020 Jun 12.
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A multicentre observational study on the epidemiology, risk factors, management and outcomes of mucormycosis in India.一项关于印度毛霉菌病的流行病学、危险因素、治疗和结局的多中心观察性研究。
多枚上颌牙周脓肿为新冠病毒感染后毛霉菌病的表现:一例报告。
J Med Case Rep. 2023 Mar 3;17(1):74. doi: 10.1186/s13256-023-03792-6.
Clin Microbiol Infect. 2020 Jul;26(7):944.e9-944.e15. doi: 10.1016/j.cmi.2019.11.021. Epub 2019 Dec 4.
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Global Epidemiology of Mucormycosis.毛霉病的全球流行病学
J Fungi (Basel). 2019 Mar 21;5(1):26. doi: 10.3390/jof5010026.
5
Diabetes mellitus and its complications in India.印度的糖尿病及其并发症。
Nat Rev Endocrinol. 2016 Jun;12(6):357-70. doi: 10.1038/nrendo.2016.53. Epub 2016 Apr 15.
6
Liposomal amphotericin B versus conventional amphotericin B in the empirical treatment of persistently febrile neutropenic patients.脂质体两性霉素B与传统两性霉素B在持续发热性中性粒细胞减少患者经验性治疗中的比较
J Antimicrob Chemother. 2002 Feb;49 Suppl 1:81-6. doi: 10.1093/jac/49.suppl_1.81.