Alkhamiss Abdullah S, Ahmed Ahmed A, Rasheed Zafar, Alghsham Ruqaih, Shariq Ali, Alsaeed Thamir, Althwab Sami A, Alsagaby Suliman, Aljohani Abdullah S M, Alhumaydhi Fahad A, Alduraibi Sharifa K, Alduraibi Alaa K, Alhomaidan Homaidan T, Allemailem Khaled S, Alharbi Raya A, Alamro Samar A, Alqusayer Arwa M, Alharbi Sahim A, Alharby Thekra A, Almujaydil Mona S, Mousa Ayman M, Alghaniam Sultan A, Alghunaim Abdulrhman A, Alghamdi Rana, Fernández Nelson, Al Abdulmonem Waleed
Department of Pathology, College of Medicine, Qassim University, Buraidah, Saudi Arabia.
Research Center, College of Medicine, Qassim University, Buraidah, Saudi Arabia.
Open Life Sci. 2022 Aug 10;17(1):917-937. doi: 10.1515/biol-2022-0085. eCollection 2022.
Mucormycosis (MCM) is a rare fungal disorder that has recently been increased in parallel with novel COVID-19 infection. MCM with COVID-19 is extremely lethal, particularly in immunocompromised individuals. The collection of available scientific information helps in the management of this co-infection, but still, the main question on COVID-19, whether it is occasional, participatory, concurrent, or coincidental needs to be addressed. Several case reports of these co-infections have been explained as causal associations, but the direct contribution in immunocompromised individuals remains to be explored completely. This review aims to provide an update that serves as a guide for the diagnosis and treatment of MCM patients' co-infection with COVID-19. The initial report has suggested that COVID-19 patients might be susceptible to developing invasive fungal infections by different species, including MCM as a co-infection. In spite of this, co-infection has been explored only in severe cases with common triangles: diabetes, diabetes ketoacidosis, and corticosteroids. Pathogenic mechanisms in the aggressiveness of MCM infection involves the reduction of phagocytic activity, attainable quantities of ferritin attributed with transferrin in diabetic ketoacidosis, and fungal heme oxygenase, which enhances iron absorption for its metabolism. Therefore, severe COVID-19 cases are associated with increased risk factors of invasive fungal co-infections. In addition, COVID-19 infection leads to reduction in cluster of differentiation, especially CD4+ and CD8+ T cell counts, which may be highly implicated in fungal co-infections. Thus, the progress in MCM management is dependent on a different strategy, including reduction or stopping of implicit predisposing factors, early intake of active antifungal drugs at appropriate doses, and complete elimination via surgical debridement of infected tissues.
毛霉病（MCM）是一种罕见的真菌性疾病，最近其发病率与新型冠状病毒肺炎（COVID-19）感染同步上升。合并COVID-19的MCM极具致死性，在免疫功能低下的个体中尤为如此。收集现有的科学信息有助于管理这种合并感染，但关于COVID-19，其究竟是偶发、参与、并发还是巧合，这一主要问题仍有待解决。这些合并感染的几例病例报告已被解释为因果关联，但在免疫功能低下个体中的直接作用仍有待全面探索。本综述旨在提供最新信息，为诊断和治疗合并COVID-19的MCM患者提供指导。初步报告表明，COVID-19患者可能易发生由不同菌种引起的侵袭性真菌感染，包括合并感染MCM。尽管如此，仅在患有常见三联征（糖尿病、糖尿病酮症酸中毒和使用皮质类固醇）的重症病例中探讨了合并感染。MCM感染侵袭性的致病机制包括吞噬活性降低、糖尿病酮症酸中毒时与转铁蛋白相关的铁蛋白可获得量以及真菌血红素加氧酶，后者可增强铁吸收以促进其代谢。因此，重症COVID-19病例与侵袭性真菌合并感染的风险因素增加有关。此外，COVID-19感染导致分化簇减少，尤其是CD4+和CD8+ T细胞计数减少，这可能与真菌合并感染密切相关。因此，MCM的治疗进展取决于不同的策略，包括减少或停止潜在的易感因素、早期适当剂量使用活性抗真菌药物以及通过手术清创感染组织实现彻底清除。
