Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, Cukurova University, Campus of Balcali, Saricam, 01330, Adana, Turkey.
Department of Biostatistics, Faculty of Medicine, Cukurova University, Adana, Turkey.
Eur Arch Otorhinolaryngol. 2023 Jan;280(1):219-226. doi: 10.1007/s00405-022-07526-0. Epub 2022 Jun 29.
Our aim was to analyze the patients with diabetic rhino-orbital-cerebral mucormycosis that we have treated in our clinic in the last 5 years, and to reveal the altering conditions with COVID-19.
A retrospective study was conducted on 39 rhino-orbital-cerebral mucormycosis (ROCM) patients with diabetes mellitus between 2017 and 2022. The patients were divided into two groups as those associated with and not associated with COVID-19 and compared.
Thirty-nine diabetic patients were included in the study, with 15 (38.5%) of them being COVID-19 associated mucormycosis (CAM) group. CAM patients showed higher orbital involvement and cavernous sinus involvement (p = 0.002 and p = 0.013, respectively). The mortality rate in the non-COVID-19 associated mucormycosis (non-CAM) group was statistically higher in patients with intracranial and cavernous sinus involvement (p = 0.015 and p = 0.033, respectively). The difference between the overall survival of the CAM patients and non-CAM patients was not statistically significant (p = 0.741).
With COVID-19, progressive mucormycosis accompanied by orbital and intracranial involvement is observed more frequently. However, on the contrary, the mortality rate in COVID-19-associated mucormycosis is considerably lower than expected. The fact that temporary immune suppression can be ameliorated with adequate supportive treatment and liposomal amphotericin-B which can be given to patients in high doses may explain this situation. It has been attained hints that the essential factor in the treatment of COVID-19-associated ROCM is the control of the underlying disease and to be cautious in the decision of early aggressive surgery.
分析我们在过去 5 年中在诊所治疗的糖尿病性鼻眶脑毛霉菌病患者，并揭示与 COVID-19 相关的变化情况。
对 2017 年至 2022 年间 39 例糖尿病合并鼻眶脑毛霉菌病（ROCM）患者进行回顾性研究。将患者分为与 COVID-19 相关和不相关两组进行比较。
本研究共纳入 39 例糖尿病患者，其中 15 例（38.5%）为 COVID-19 相关毛霉菌病（CAM）组。CAM 患者的眼眶和海绵窦受累比例更高（p=0.002 和 p=0.013）。非 COVID-19 相关毛霉菌病（non-CAM）组中，颅内和海绵窦受累患者的死亡率明显更高（p=0.015 和 p=0.033）。CAM 患者和 non-CAM 患者的总体生存率差异无统计学意义（p=0.741）。
COVID-19 时，更常观察到伴有眼眶和颅内受累的进行性毛霉菌病。然而，出乎意料的是，COVID-19 相关毛霉菌病的死亡率明显低于预期。这种情况可能是由于暂时的免疫抑制可以通过充分的支持治疗和大剂量给予患者脂质体两性霉素 B 得到改善。这表明 COVID-19 相关 ROCM 治疗的关键因素是控制基础疾病，并在早期积极手术决策时要谨慎。
