Department of Infectious diseases and HIV/AIDS, Noble hospitals and Research Centre, Pune, MH, India.
Department of Medicine, Noble hospital and Research Centre, Pune, India.
Mycoses. 2022 May;65(5):526-540. doi: 10.1111/myc.13435. Epub 2022 Mar 10.
The second COVID-19 wave in India has been associated with an unprecedented increase in cases of COVID-19 associated mucormycosis (CAM), mainly Rhino-orbito-cerebral mucormycosis (ROCM).
This retrospective cohort study was conducted at Noble hospital and Research Centre (NHRC), Pune, India, between 1 April, 2020, and 1 August, 2021, to identify CAM patients and assess their management outcomes. The primary endpoint was incidence of all-cause mortality due to CAM.
59 patients were diagnosed with CAM. Median duration from the first positive COVID-19 RT PCR test to diagnosis of CAM was 17 (IQR: 12,22) days. 90% patients were diabetic with 89% having uncontrolled sugar level (HbA1c >7%). All patients were prescribed steroids during treatment for COVID-19. 56% patients were prescribed steroids for non-hypoxemic, mild COVID-19 (irrational steroid therapy), while in 9%, steroids were prescribed in inappropriately high dose. Patients were treated with a combination of surgical debridement (94%), intravenous liposomal Amphotericin B (91%) and concomitant oral Posaconazole (95.4%). 74.6% patients were discharged after clinical and radiologic recovery while 25.4% died. On relative risk analysis, COVID-19 CT severity index ≥18 (p = .017), presence of orbital symptoms (p = .002), presence of diabetic ketoacidosis (p = .011) and cerebral involvement (p = .0004) were associated with increased risk of death.
CAM is a rapidly progressive, angio-invasive, opportunistic fungal infection, which is fatal if left untreated. Combination of surgical debridement and antifungal therapy leads to clinical and radiologic improvement in majority of cases.
印度第二波 COVID-19 疫情与 COVID-19 相关毛霉菌病（CAM）病例的空前增加有关，主要是鼻-眶-脑毛霉菌病（ROCM）。
本回顾性队列研究于 2020 年 4 月 1 日至 2021 年 8 月 1 日在印度浦那的 Noble 医院和研究中心（NHRC）进行，旨在确定 CAM 患者并评估其治疗结果。主要终点是因 CAM 导致的全因死亡率。
共诊断出 59 例 CAM 患者。从首次 COVID-19 RT-PCR 检测呈阳性到诊断为 CAM 的中位时间为 17 天（IQR：12，22）。90%的患者患有糖尿病，其中 89%血糖控制不佳（HbA1c>7%）。所有患者在 COVID-19 治疗期间均接受了类固醇治疗。56%的患者因非低氧血症、轻度 COVID-19 而接受了类固醇治疗（不合理的类固醇治疗），而在 9%的患者中，类固醇的剂量过高。患者接受了手术清创（94%）、静脉注射两性霉素 B 脂质体（91%）和同时口服泊沙康唑（95.4%）的联合治疗。74.6%的患者在临床和影像学恢复后出院，而 25.4%的患者死亡。在相对风险分析中，COVID-19 CT 严重指数≥18（p=0.017）、存在眼眶症状（p=0.002）、存在糖尿病酮症酸中毒（p=0.011）和脑受累（p=0.0004）与死亡风险增加相关。
CAM 是一种迅速进展的、血管侵袭性的、机会性真菌感染，如果不治疗则会致命。手术清创和抗真菌治疗的联合应用可使大多数患者的临床和影像学症状得到改善。
