Bhadania Simple, Bhalodiya Neena, Sethi Yashendra, Kaka Nirja, Mishra Swati, Patel Neil, Wasim Asad Ullah, Joshi Saumya S, Shah Kenisha
Otorhinolaryngology, Gujarat Medical Education & Research Society (GMERS) Medical College Sola, Ahmedabad, IND.
Medicine, Government Doon Medical College, Dehradun, IND.
Cureus. 2021 Dec 21;13(12):e20569. doi: 10.7759/cureus.20569. eCollection 2021 Dec.
Introduction Coronavirus disease 2019 (COVID-19) disease attributed to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has shown associations with various fungal opportunistic infections such as mucormycosis, invasive candidiasis, and aspergillosis, which have contributed to the mortality of the disease. In India, the incidence of mucormycosis had risen rapidly during the second wave. There is ample literature demonstrating the role of iron in the pathogenesis of mucormycosis. The hyperferritinemia associated with COVID-19 may have played a significant role in promoting the invasion and extent of the fungus. Aims and objectives The study aimed to analyze the association between serum ferritin levels and the extent of involvement of mucormycosis in patients affected with COVID-19. Methodology A single-center cross-sectional study was conducted using retrospective hospital record data. G*Power statistical analysis software was used to compute the sample size of 62 (31+31). The radiological data were used to determine the extent of involvement. Results A statistically significant difference was seen in levels of serum ferritin (p = 0.008) between the radiologically judged two groups of the mild extent of invasion of mucormycosis (rhinosinusitis) and severe extent of invasion (rhino-orbital/cerebral mucormycosis), with a severe extent seen with the group having higher levels of serum ferritin. Severe extent of invasion was seen in 53.6% of patients with diabetes mellitus and 62.5% of patients with both diabetes and hypertension. Conclusion The hyperferritinemia not only presents as a marker of the systemic inflammatory process in COVID-19 but also indicates increased free iron, which thereby aids the growth and extent of involvement by the fungus ( ). In individuals with diabetes and hypertension, the severity was greater. Controlling catastrophic outcomes in individuals with high serum ferritin levels necessitates extra caution.
引言 2019 冠状病毒病（COVID-19）是由严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）引起的疾病，已显示出与各种真菌机会性感染相关，如毛霉菌病、侵袭性念珠菌病和曲霉病，这些感染导致了该疾病的死亡率。在印度，第二波疫情期间毛霉菌病的发病率迅速上升。有大量文献证明铁在毛霉菌病发病机制中的作用。与 COVID-19 相关的高铁蛋白血症可能在促进真菌的侵袭和扩散方面发挥了重要作用。目的 本研究旨在分析 COVID-19 患者血清铁蛋白水平与毛霉菌病受累程度之间的关联。方法 使用回顾性医院记录数据进行单中心横断面研究。使用 G*Power 统计分析软件计算样本量为 62（31 + 31）。放射学数据用于确定受累程度。结果 在放射学判断的两组毛霉菌病轻度侵袭（鼻-鼻窦炎）和重度侵袭（鼻-眶/脑毛霉菌病）中，血清铁蛋白水平存在统计学显著差异（p = 0.008），血清铁蛋白水平较高的组显示为重度侵袭。53.6% 的糖尿病患者和 62.5% 的糖尿病合并高血压患者出现重度侵袭。结论 高铁蛋白血症不仅是 COVID-19 全身炎症过程的标志物，还表明游离铁增加，从而有助于真菌的生长和受累程度（ ）。在糖尿病和高血压患者中，病情更严重。对血清铁蛋白水平高的个体控制灾难性后果需要格外谨慎。
