Government Kilpauk Medical College, Chennai.
J Assoc Physicians India. 2022 Apr;70(4):11-12.
To find the association between CAM and diabetes and correlate the severity of glycemic status,and clinical features and morbidity associated with them.
This descriptive study was conducted at a COVID Ward in govt kilpauk med college from Apr 10, 2021 to Aug 1 0, 2021. All laboratory confirmed COVID-19 cases by RTPCR (Real Time Reverse Transcription Polymerse Chain Reaction) nasopharyngeal & throat swab were admitted at this centre. Severe COVID-19 infection was defined bySp02<90%orRespiratory rate >30/min at admi during hospital stay. Post COVID 19 cases were defined who had either clinical recovery from respiratory symptoms or had passed 28 days since the onset of symptoms of COVID 19. Lymphocytopenia was defined by absolute lymphocyte count<1000/mm3.Data compiled in Ms-excel sheet and studied.
In Patients with CAM30/32(93.8%) hadheadache,20/32(62.5%) had nasal symptoms in form of rhinorrhoea & nasal stuffiness and 19/32(59.4%) had eyes symptoms in form of red nessoreye pain. O n admission, 18/32 (56.2%) patients had history or presented with Severe COVID-19 pneumonia. At the time of diagnosis of CAM, 22/ 32 (68.8%) had hypoxemia and required supplemental oxygen. The mean duration from onset of COVID-19 to diagnosis of CAM was 17.28 (±11.76) days. In patients with CAM, none of them were fully vaccinated against COVID-19. Two patients had received a single dose of (Covishield) COVID-19 vaccine. Both the patients are still admitted at our centre and are on antifungal therapy. Among 822 hospitalized patients with COVID 19 infection, 36 patients had CAM with an incidence of 3.9%. In patients with CAM, 84.5% had Diabetes Mellitus as the most common co-morbidity. The majority of the patients had poor glycemic control with a mean HbA1c of 8.06%. Out of the total population, 88% had prior exposure to high dose corticosteroids.surgical debridement done for 65%of patients and others treated withantifungals. During the study period, 36% patients of CAM did not survive.
Mucormycosis is a formidable angioinvasive opportunistic infection in an immunocompromised host. The spectrum of mucormycosis involves rhino-orbital-cerebral, pulmonary, disseminated, cutaneous, gastrointestinal and disseminated form of disease. The major risk factors for the disease are diabetes, neutropenia, iron overload, malignancy and organ transplant. Diabetes is the most common metabolic disorder and is an independent risk factor for Severe COVID-19 and Mucormycosis. In patients with diabetes affected with COVID-19 superinfection with Mucormycosis will lead to adverse clinical outcome and prolonged hospital stay.
探讨 CAM 与糖尿病的相关性，并分析血糖状态的严重程度、临床特征和与之相关的发病率。
本描述性研究于 2021 年 4 月 10 日至 2021 年 8 月 1 日在政府 Kilpauk 医学院的 COVID 病房进行。所有经 RT-PCR（实时逆转录聚合酶链反应）鼻咽和咽喉拭子检测确诊的 COVID-19 病例均纳入本研究中心。严重 COVID-19 感染定义为住院期间 Sp02＜90%或呼吸频率＞30/min。COVID 后病例定义为有呼吸道症状临床恢复或 COVID-19 症状出现后已过去 28 天。淋巴细胞减少症定义为绝对淋巴细胞计数＜1000/mm3。数据在 Ms-excel 表中进行编译和研究。
在患有 CAM 的 30/32 例患者（93.8%）中，有 30/32 例（93.8%）有头痛，20/32 例（62.5%）有鼻症状，如流鼻涕和鼻塞，19/32 例（59.4%）有眼部症状，如眼红或眼痛。入院时，18/32 例（56.2%）患者有或出现严重 COVID-19 肺炎的病史。在诊断 CAM 时，22/32 例（68.8%）有低氧血症，需要补充氧气。从 COVID-19 发病到诊断 CAM 的平均时间为 17.28（±11.76）天。在患有 CAM 的患者中，均未接种过 COVID-19 疫苗。有 2 名患者接种过一剂（Covishield）COVID-19 疫苗。这两名患者仍在我们中心接受治疗，并接受抗真菌治疗。在 822 例住院 COVID-19 感染患者中，有 36 例患有 CAM，发病率为 3.9%。在患有 CAM 的患者中，糖尿病是最常见的合并症，占 84.5%。大多数患者血糖控制不佳，平均 HbA1c 为 8.06%。在总人群中，88%的患者有高剂量皮质类固醇暴露史。65%的患者接受了外科清创术，其余患者接受了抗真菌治疗。在研究期间，36%的 CAM 患者未能存活。
毛霉菌病是一种在免疫功能低下宿主中具有侵袭性的血管内机会性感染。毛霉菌病的范围包括鼻-眶-脑、肺、播散性、皮肤、胃肠道和播散性疾病。该疾病的主要危险因素是糖尿病、中性粒细胞减少、铁过载、恶性肿瘤和器官移植。糖尿病是最常见的代谢性疾病，也是 COVID-19 和毛霉菌病严重程度的独立危险因素。患有糖尿病的 COVID-19 患者合并毛霉菌病感染会导致不良的临床结局和延长住院时间。
