Madhavan Yasasve, Sai Kadambari Vijay, Shanmugam Dilip Kumar, Manimaran Aashabharathi, Guruviah Karthigadevi, Mohanta Yugal Kishore, Venugopal Divyambika Catakapatri, Mohanta Tapan Kumar, Sharma Nanaocha, Muthupandian Saravanan
Department of Oral Medicine and Radiology, Faculty of Dental Sciences, Sri Ramachandra Institute of Higher Education and Research, Chennai 600116, India.
Centre for Biotechnology, Anna University, Chennai 600025, India.
J Clin Med. 2022 Jun 23;11(13):3620. doi: 10.3390/jcm11133620.
Mucormycosis has become increasingly associated with COVID-19, leading to the use of the term "COVID-19 associated mucormycosis (CAM)". Treatment of CAM is challenging due to factors such as resistance to many antifungals and underlying co-morbidities. India is particularly at risk for this disease due to the large number of patients with COVID-19 carrying comorbidities that predispose them to the development of mucormycosis. Additionally, mucormycosis treatment is complicated due to the atypical symptoms and delayed presentation after the resolution of COVID-19. Since this disease is associated with increased morbidity and mortality, early identification and diagnosis are desirable to initiate a suitable combination of therapies and control the disease. At present, the first-line treatment involves Amphotericin B and surgical debridement. To overcome limitations associated with surgery (invasive, multiple procedures required) and amphotericin B (toxicity, extended duration and limited clinical success), additional therapies can be utilized as adjuncts or alternatives to reduce treatment duration and improve prognosis. This review discusses the challenges associated with treating CAM and the critical aspects for controlling this invasive fungal infection-early diagnosis and initiation of therapy, reversal of risk factors, and adoption of a multipronged treatment strategy. It also details the various therapeutic options (in vitro, in vivo and human case reports) that have been used for the treatment of CAM.
毛霉菌病与新型冠状病毒肺炎（COVID-19）的关联日益增加，因此出现了“COVID-19相关毛霉菌病（CAM）”这一术语。由于对多种抗真菌药物耐药以及存在基础合并症等因素，CAM的治疗具有挑战性。由于大量COVID-19患者伴有易患毛霉菌病的合并症，印度尤其面临这种疾病的风险。此外，由于症状不典型以及COVID-19康复后出现症状延迟，毛霉菌病的治疗变得复杂。鉴于这种疾病会增加发病率和死亡率，因此需要尽早识别和诊断，以便启动合适的联合治疗并控制病情。目前，一线治疗包括两性霉素B和手术清创。为克服与手术（侵入性、需要多次手术）和两性霉素B（毒性、疗程长且临床成功率有限）相关的局限性，可以采用其他疗法作为辅助或替代方法，以缩短治疗时间并改善预后。本综述讨论了治疗CAM所面临的挑战以及控制这种侵袭性真菌感染的关键方面——早期诊断和开始治疗、逆转危险因素以及采用多管齐下的治疗策略。它还详细介绍了用于治疗CAM的各种治疗选择（体外、体内和人类病例报告）。
