Alian Shahriar, Ahangarkani Fatemeh, Boskabadi Seyyed Javad, Kargar-Soleimanabad Saeed, Delavarian Leila, Pakzad Azalia
Antimicrobial Resistance Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran.
Department of Clinical Pharmacy, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran.
Ann Med Surg (Lond). 2022 Jun;78:103911. doi: 10.1016/j.amsu.2022.103911. Epub 2022 Jun 4.
and importance: There are increasing case reports of mucormycosis in patient with coronavirus disease 2019 (Covid-19). Herein, we describe the case of mucormycosis after recovery from Covid-19.
The patient was a 73 years old woman with a history of chronic kidney disease, diabetes mellitus, hypertension, and dyslipidemia that referred to the emergency department with clinical presentation of Covid-19. On the third day of admission, the Covid-19 PCR test was negative, but the patient presented headache and pain in her upper jaw. Physical examination showed fever, erythema, and tenderness in the right cheek. Emergency biopsy and culture from sinus by subsection to mucormycosis conducted. and the diagnosis of mucormycosis was confirmed by the positive result of biopsy and culture. Despite anti-fungal treatment with Amphotericin B, patient developed severe diarrhea and became hemodynamically unstable. In the stool analysis, Strongyloides stercoralis was reported. Unfortunately, patient was expired on day thirty-two of this admission.
Mucormycosis is a dangerous infection, and its rapid diagnosis is so important. On the other hand, Covid-19 may associated with many nonspecific sign and symptoms. These finding may overlap with other infections.In patients with prolonged mucormycosis infection, the development of strongyloidiasis should not be neglected. A single dose of ivermectin as strongyloidiasis prophylaxis should be given if the duration of the illness is prolonged.
Clinicians should consider mucormycosis and its complications after Covid-19 treatment in diabetic and immunocompromised patients.
及其重要性:2019冠状病毒病(Covid-19)患者中毛霉菌病的病例报告日益增多。在此,我们描述一例Covid-19康复后发生毛霉菌病的病例。
患者为一名73岁女性,有慢性肾病、糖尿病、高血压和血脂异常病史,因Covid-19临床表现被转诊至急诊科。入院第三天,Covid-19聚合酶链反应(PCR)检测呈阴性,但患者出现头痛和上颌疼痛。体格检查显示右侧脸颊发热、红斑和压痛。对鼻窦进行紧急活检并分段培养以检测毛霉菌病,活检和培养结果阳性确诊为毛霉菌病。尽管使用两性霉素B进行抗真菌治疗,患者仍出现严重腹泻并血流动力学不稳定。粪便分析报告发现粪类圆线虫。不幸的是,患者在此次入院第32天死亡。
毛霉菌病是一种危险的感染,快速诊断非常重要。另一方面,Covid-19可能伴有许多非特异性体征和症状。这些表现可能与其他感染重叠。在毛霉菌病感染持续时间较长的患者中,不应忽视类圆线虫病的发生。如果病程延长,应给予单剂量伊维菌素预防类圆线虫病。
临床医生应在糖尿病和免疫功能低下患者的Covid-19治疗后考虑毛霉菌病及其并发症。