Bangalore Medical College and Research Institute, Bangalore.
J Assoc Physicians India. 2022 Apr;70(4):11-12.
The recent second wave of COVID-19 cases in India has been marked by an unexpected increase in cases of mucormycosis reported in the context of COVID illness. Herein we aim to identify risk factors that may explain the sudden surge of cases and help develop preventive strategies.
We performed a case-control study comparing cases diagnosed with CAM and those who had recovered from COVID-19 without developing mucormycosis (controls). Information on comorbidities, glycemic control, and practices related to COVID-19 treatment was recorded.
100 patients of CAM (cases) and 150 patients of COVID-19 without mucormycosis (controls) were included in the study. The spectrum of involvement of CAM cases included rhino-sinus (n=98, 98%), rhino orbital (n=58, 58%), rhino-orbito-cerebral (n=29, 29%). In CAM group symptoms of mucormycosis began a mean of 13.46 days after onset of COVID-19. The mean age of the CAM study group was 51.16 years with 69 males (69%) and 31 females (31.0). The most frequent comorbidities seen in our study population was diabetes (n=113, 45.2%) and hypertension (n=54, 21.6%). Diabetes was significantly more frequent among cases than controls (89% vs 24%, p <0.001). 31% of patients in CAM case group showed a common practise of steam inhalation during covid illness. Most common symptom reported in CAM was related to the eye which included eye pain (58%), lid swelling (54%), eye swelling (47%). Sino-nasal symptoms were nasal discharge (25%), nasal stuffiness (21%), and epistaxis (4%). Other common symptoms were headache (51%) and facial pain (36%). On examination of nasal cavity, crusting and ulceration were present in 83% patients. Eye involvement was present in 60% of cases, of which 27% of cases had vision loss. For definitive diagnosis of CAM, Potassium hydroxide (KOH) mount was positive for aseptate hyphae in 31 patients (31%). Use of systemic steroids for the management of COVID-19, was more frequent in CAM case group than control group (n=70, 70%). The CAM case group showed mean Hba1c of 10.7 ± 2.45, mean Serum Iron levels was 49.01 ± 18.69, mean ferritin was 913.37, mean CRP was 131.56 and mean LDH was 428.70.
Overzealous use of steroids, uncontrolled sugars and repeated steam inhalation provided a favourable environment for the growth of mucormycosis. Judicious use of steroids and stringent glycemic control are vital to preventing mucormycosis.
识别可能解释病例突然激增的因素，并帮助制定预防策略。
我们进行了一项病例对照研究，比较了患有 CAM 和已从 COVID-19 中康复但未发生毛霉菌病（对照组）的患者。记录了合并症、血糖控制和与 COVID-19 治疗相关的实践信息。
共纳入 100 例 CAM 患者（病例）和 150 例未发生毛霉菌病的 COVID-19 患者（对照组）。CAM 患者中涉及的范围包括鼻-鼻窦（n=98，98%）、鼻-眼眶（n=58，58%）、鼻-眼眶-脑（n=29，29%）。在 CAM 组中，毛霉菌病症状在 COVID-19 发病后平均 13.46 天开始出现。CAM 研究组的平均年龄为 51.16 岁，男性 69 例（69%），女性 31 例（31.0%）。我们研究人群中最常见的合并症是糖尿病（n=113，45.2%）和高血压（n=54，21.6%）。病例组中糖尿病的发生率明显高于对照组（89% vs 24%，p <0.001）。CAM 病例组中有 31%的患者在 COVID 患病期间有共同的蒸汽吸入习惯。CAM 中最常见的症状与眼睛有关，包括眼痛（58%）、眼睑肿胀（54%）、眼睛肿胀（47%）。鼻-鼻窦症状包括鼻腔分泌物（25%）、鼻塞（21%）和鼻出血（4%）。其他常见症状包括头痛（51%）和面部疼痛（36%）。在鼻腔检查中，83%的患者存在结痂和溃疡。眼受累发生在 60%的病例中，其中 27%的病例有视力丧失。为了明确 CAM 的诊断，31 例（31%）患者的氢氧化钾（KOH）载片呈无菌丝阳性。CAM 病例组中使用全身性类固醇治疗 COVID-19 的频率高于对照组（n=70，70%）。CAM 病例组的平均 Hba1c 为 10.7±2.45，平均血清铁水平为 49.01±18.69，平均铁蛋白为 913.37，平均 CRP 为 131.56，平均 LDH 为 428.70。
类固醇的过度使用、血糖控制不佳和反复蒸汽吸入为毛霉菌病的生长提供了有利环境。类固醇的合理使用和严格的血糖控制对于预防毛霉菌病至关重要。
