Department of Pathology, Thanjavur Medical College, Thanjavur, Tamil Nadu, India.
Department of Ophthalmology, Thanjavur Medical College, Thanjavur, Tamil Nadu, India.
Indian J Ophthalmol. 2022 Mar;70(3):1013-1018. doi: 10.4103/ijo.IJO_2366_21.
Known predisposing factors for mucormycosis are neutropenia and diabetes. Though COVID-19 is associated with hyperinflammatory response, a high surge in rhino-orbital-cerebral mucormycosis (ROCM) cases was observed during the second wave. The histopathological features reflect the background pathogenesis. This study analyzes the histopathological features and clinical presentation of COVID-19-associated ROCM.
In this retrospective observational study, the clinical details of 89 proven ROCM patients treated during May-July 2021 were collected from the case records. Histopathological features were correlated with clinical staging groups and outcomes. The mean neutrophil-to-lymphocyte ratio (NLR) of clinical and outcome groups were compared.
The mean age was 54.71 ± 11.03 years, with male patients constituting a majority (78.7%). Uncontrolled diabetes mellitus was noted in 70.8% of patients, and 3.4% had normal range of blood sugar. The mean blood sugar was 298.08 ± 99.51 mg/dL. The mean duration of onset of symptoms of mucormycosis from the diagnosis of COVID-19 was 17.36 ± 7.392 (3-45) days. Poor outcome with disease progression or death occurred in 21.3% of patients. Clinical group II patients (44.9%) with ROCM stages 3c and above had poor outcomes (P = 0.005). Histopathological analysis showed minimal inflammation in 25.8%, neutrophil extracellular trap (NET) in 75.3%, and angio-invasion in 28.1% of patients. Minimal inflammation was associated with clinical group II (P = 0.004) and poor outcome (P = 0.001). Angio-invasion correlated with poor outcome (P = 0.007). Patients with severe clinical group and poor outcome had higher mean NLR with P = 0.017 and P = 0.007, respectively.
Vision loss and cerebral involvement had poor outcomes. The histopathologic features such as inflammation and angio-invasion along with NLR aid as prognostic indicators in the management of ROCM. The role of NET in the pathogenesis of COVID-19-associated ROCM needs further studies.
已知毛霉菌病的易患因素包括中性粒细胞减少症和糖尿病。虽然 COVID-19 与过度炎症反应有关，但在第二波疫情中，观察到鼻-眶-脑毛霉菌病（ROCM）病例急剧增加。组织病理学特征反映了潜在的发病机制。本研究分析了与 COVID-19 相关的 ROCM 的组织病理学特征和临床表现。
在这项回顾性观察性研究中，从病历中收集了 2021 年 5 月至 7 月期间治疗的 89 例确诊为 ROCM 的患者的临床详细信息。将组织病理学特征与临床分期组和结局相关联。比较了临床和结局组的中性粒细胞与淋巴细胞比值（NLR）。
患者的平均年龄为 54.71 ± 11.03 岁，男性患者占多数（78.7%）。70.8%的患者患有未控制的糖尿病，3.4%的患者血糖正常。平均血糖为 298.08 ± 99.51mg/dL。从 COVID-19 诊断到毛霉菌病症状发作的平均时间为 17.36 ± 7.392（3-45）天。21.3%的患者病情进展或死亡，预后不良。ROCM 分期为 3c 及以上的临床 II 组（44.9%）患者预后不良（P = 0.005）。组织病理学分析显示，25.8%的患者炎症轻微，75.3%的患者有中性粒细胞胞外陷阱（NET），28.1%的患者有血管侵袭。炎症轻微与临床 II 组相关（P = 0.004）和不良预后相关（P = 0.001）。血管侵袭与不良预后相关（P = 0.007）。临床情况严重且预后不良的患者的平均 NLR 较高，分别为 P = 0.017 和 P = 0.007。
视力丧失和脑部受累预后不良。炎症和血管侵袭等组织病理学特征以及 NLR 可作为 ROCM 管理的预后指标。NET 在 COVID-19 相关 ROCM 发病机制中的作用需要进一步研究。
