Gherlan George Sebastian, Hoara Maria Cristina, Smadu Sebastian George, Popescu Corneliu Petru, Ionescu Petronela, Florescu Simin-Aysel
Department of Infectious Diseases, "Dr. Victor Babes" Clinical Hospital of Infectious and Tropical Diseases, Bucharest, Romania.
Maedica (Bucur). 2022 Mar;17(1):215-225. doi: 10.26574/maedica.2022.17.1.215.
COVID-19 has proven to be an independent risk factor for secondary infectious complications. Amongst them, mucormycosis has recently been noticed more frequently than in the past. Caused by molds belonging to the order, this is a rare, but potentially fatal infection unless adequately treated. Ear, nose and throat involvement is prevalent with often expansion to the orbit, sinuses or brain. Pulmonary, cutaneous and gastrointestinal infections are also recognized. Classical risk factors for progression to angioinvasive disease include poorly controlled diabetes mellitus, defects in phagocytic function (prolonged neutropenia, glucocorticoid treatment), immunosuppressive therapy associated with transplantation, malignancy, elevated levels of free iron as well as iron chelators (deferoxamine). In addition, immune dysregulation rendered by COVID-19 itself may contribute or solely lead to invasive mold disease. The largest experience comes from India, which has dealt with a challenging epidemic of COVID-19-associated mucormycosis (CAM). To our knowledge, no previous studies have reported CAM in Romania. We therefore present a case of severe COVID-19 pneumonia initially complicated by bacterial superinfection and secondary sepsis at admission in an unvaccinated 61-year-old male who presented in our clinic with respiratory failure and digestive symptoms. Although improvement occurred rapidly following antiviral, empiric large spectrum Intraantibiotics and pathogenic medication, unfavorable clinical course ensued later on. Biological and imaging investigations were consistent with pulmonary superinfection in the form of multiple different-sized upper right field opacities, which eventually evolved to form cavities. Differential diagnosis was thoroughly performed. Since unable to sterilize the lung by means of medication alone, the patient underwent major thoracic surgery with removal of the entire right lung. Microscopic study of the damaged tissue was able to determine the presence of broad, aseptate hyphae which morphologically belong to Mucorales. A diagnosis of pulmonary mucormycosis was established and proper antifungal treatment was initiated, with full recovery of the patient.
新型冠状病毒肺炎（COVID-19）已被证明是继发性感染并发症的独立危险因素。其中，毛霉菌病最近比过去更频繁地被注意到。这是一种由毛霉目霉菌引起的罕见但可能致命的感染，除非得到充分治疗。耳、鼻、喉受累很常见，常扩展至眼眶、鼻窦或脑部。肺部、皮肤和胃肠道感染也有报道。进展为血管侵袭性疾病的经典危险因素包括糖尿病控制不佳、吞噬功能缺陷（长期中性粒细胞减少、糖皮质激素治疗）、与移植相关的免疫抑制治疗、恶性肿瘤、游离铁以及铁螯合剂（去铁胺）水平升高。此外，COVID-19本身导致的免疫失调可能促成或单独导致侵袭性霉菌病。最大的经验来自印度，该国应对了具有挑战性的COVID-19相关毛霉菌病（CAM）疫情。据我们所知，罗马尼亚此前没有关于CAM的研究报告。因此，我们报告一例61岁未接种疫苗的男性患者，因呼吸衰竭和消化症状就诊于我们诊所，入院时患有严重的COVID-19肺炎，最初并发细菌重叠感染和继发性脓毒症。尽管在抗病毒、经验性广谱抗生素和抗病原体药物治疗后迅速出现改善，但随后临床病程不佳。生物学和影像学检查与肺部重叠感染一致，表现为右上叶多个不同大小的opacity，最终发展为空洞。进行了全面的鉴别诊断。由于仅靠药物无法清除肺部感染，患者接受了大型胸外科手术，切除了整个右肺。对受损组织的显微镜检查能够确定存在形态上属于毛霉目的宽大、无隔菌丝。确诊为肺毛霉菌病并开始适当的抗真菌治疗，患者完全康复。
