Almyroudi Maria Panagiota, Akinosoglou Karolina, Rello Jordi, Blot Stijn, Dimopoulos George
Department of Emergency Medicine, University Hospital Attikon, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece.
Department of Internal Medicine and Infectious Diseases, University General Hospital of Patras, School of Medicine University of Patras, 26504 Rio, Greece.
Diagnostics (Basel). 2022 Dec 8;12(12):3092. doi: 10.3390/diagnostics12123092.
A mucormycosis surge was reported during the COVID-19 pandemic in India. A literature search until 14 July 2022, with the aim of updating COVID-19-associated mucormycosis (CAM), identified 663 studies and 88 met inclusion criteria (8727 patients). India reported 8388 patients, Egypt 208 and Europe 40. Rhino-orbito-cerebral mucormycosis (ROCM) was identified among 8082 (98.3%) patients, followed by 98 (1.2%) with pulmonary. In India, 82.6% of patients had diabetes mellitus, with 82% receiving corticosteroids. In Europe, 75% presented pulmonary CAM, 32.5% had diabetes and 40% were immunocompromised. CAM was identified at a median of 17.4 days (IQR 7.5 days) post COVID-19 diagnosis, and PCR was performed in five studies. Rhino-orbital invasion is clinically obvious, while cerebral involvement presents with cavernous sinus thrombosis, meningitis and cerebrovascular disease. Symptoms of pulmonary CAM usually overlap with severe COVID-19 pneumonia. High-dose liposomal Amphotericin B (and early surgical debridement in ROCM) are the mainstay of therapy. The median mortality rate was estimated to be 21.4% (IQR 31.9%), increased by the presence of pulmonary (80% (IQR 50%) or cerebral involvement (50% (IQR 63.9%). In summary, different CAM clinical phenotypes need to be distinguished, influenced by geographical presentation. Opportunities exist for diagnosis and therapy optimization, based on earlier high-dose antifungal therapy, early source control, strict glycemic control and restriction of steroids to COVID-19 patients with oxygen requirements.
印度在新冠疫情期间报告了毛霉病激增的情况。截至2022年7月14日进行的文献检索，旨在更新与新冠相关的毛霉病（CAM），共识别出663项研究，其中88项符合纳入标准（8727例患者）。印度报告了8388例患者，埃及208例，欧洲40例。8082例（98.3%）患者被诊断为鼻眶脑型毛霉病（ROCM），其次是98例（1.2%）肺部毛霉病。在印度，82.6%的患者患有糖尿病，82%的患者接受过皮质类固醇治疗。在欧洲，75%的患者表现为肺部CAM，32.5%患有糖尿病，40%存在免疫功能低下。CAM在新冠诊断后的中位时间为17.4天（四分位间距7.5天），五项研究中进行了PCR检测。鼻眶侵犯在临床上很明显，而脑部受累表现为海绵窦血栓形成、脑膜炎和脑血管疾病。肺部CAM的症状通常与重症新冠肺炎重叠。高剂量脂质体两性霉素B（以及ROCM的早期手术清创）是主要治疗方法。估计中位死亡率为21.4%（四分位间距31.9%），肺部受累（80%（四分位间距50%））或脑部受累（50%（四分位间距63.9%））会增加死亡率。总之，不同的CAM临床表型需要区分，这受地域表现的影响。基于早期高剂量抗真菌治疗、早期源头控制、严格血糖控制以及对有吸氧需求的新冠患者限制使用类固醇，存在诊断和治疗优化的机会。
