Department of Microbiology, ESIC Medical College and Hospital.
Department of ENT, ESIC Medical College and Hospital.
Med Mycol J. 2022;63(3):59-64. doi: 10.3314/mmj.21-00019.
Acute invasive fungal rhinosinusitis is a rare infection primarily affecting patients with co-morbidities like immunosuppression and poorly controlled diabetes. Mucormycosis is increasingly being reported in patients with SARS-CoV-2 (COVID-19). However, reports of coinfection of aspergillosis and mucormycosis involving nose, paranasal sinuses, orbit, and brain are rare in literature. We aimed to evaluate the patient demographics, clinical presentation, and management of cases presenting with mixed infection. We carried out retrospective analysis of 12 patients with confirmed diagnosis of mixed invasive fungal infections post-COVID-19 disease out of 70 cases of COVID-19-associated mucormycosis (CAM) presenting to a tertiary-level hospital in North India from May to June 2021. All patients had diabetes mellitus; the mean age was 48 years. The common presenting features were headache, nasal congestion, palatal ulcer, and vision loss accompanied by facial pain and swelling. Two patients developed cerebral abscess during the course of treatment; three patients had concurrent COVID-19 pneumonia. All patients received systemic liposomal amphotericin B and serial surgical debridements. The overall mortality rate was 16.7%. Our study demonstrates that mucormycosis and aspergillosis are angioinvasive mycoses that are clinically and radiologically identical. KOH direct mount of clinical sample showing septate hyphae should be extensively searched for aseptate hyphae after digestion and clearing of the tissue. A high index of suspicion of mixed infection post-COVID-19 and early initiation of liposomal amphotericin B followed by prompt surgical intervention can reduce the overall morbidity and mortality among patients with this condition.
急性侵袭性真菌性鼻-鼻窦炎是一种罕见的感染，主要影响合并免疫抑制和未控制良好的糖尿病等合并症的患者。在 SARS-CoV-2（COVID-19）患者中，越来越多地报告了毛霉菌病。然而，文献中很少有涉及鼻、副鼻窦、眼眶和大脑的曲霉病和毛霉菌病合并感染的报道。我们旨在评估患有 COVID-19 后混合感染的患者的人口统计学、临床表现和管理。我们对 2021 年 5 月至 6 月期间印度北部一家三级医院收治的 70 例 COVID-19 相关毛霉菌病（CAM）患者中确诊为 COVID-19 后混合侵袭性真菌感染的 12 例患者进行了回顾性分析。所有患者均患有糖尿病；平均年龄为 48 岁。常见的表现特征是头痛、鼻塞、腭溃疡和视力丧失，伴有面部疼痛和肿胀。两名患者在治疗过程中出现脑脓肿；三名患者同时患有 COVID-19 肺炎。所有患者均接受了系统的脂质体两性霉素 B 和连续的手术清创。总死亡率为 16.7%。我们的研究表明，毛霉菌病和曲霉病是血管侵袭性真菌病，在临床上和影像学上是相同的。在消化和清除组织后，应广泛搜索 KOH 直接镜检显示的分隔菌丝，以寻找无隔菌丝。对 COVID-19 后混合感染保持高度怀疑，并早期开始使用脂质体两性霉素 B，随后及时进行手术干预，可以降低此类患者的整体发病率和死亡率。
