Mehfooz Samreen, Mehrotra Neelima, Usmani Tarim, Raj Vivek
Department of Ophthalmology, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, IND.
Department of Radiodiagnosis, Career Institute of Medical Sciences & Hospital, Lucknow, IND.
Cureus. 2022 Nov 23;14(11):e31822. doi: 10.7759/cureus.31822. eCollection 2022 Nov.
Introduction and aim Mucormycosis is a rare but serious angio-invasive infection caused by a group of fungi called mucormycetes and it mainly affects people who are immunocompromised, or patients already infected with other diseases. The dreaded mucormycosis infection has recently gained gross ill-repute for having claimed many lives in coronavirus disease (COVID-19) and/or post-COVID-19 patients. Hence a need was felt to study the development of mucormycosis in COVID-19 patients to better prevent and treat this fungal infection in anticipated future waves of the pandemic. This study also aims to establish an association between COVID-19 positivity, systemic comorbidities, and treatment modalities with the possibility of occurrence of vision and life-threatening mucor infection of the nose, paranasal sinuses, orbit, and brain. Methods This is a hospital-based, retrospective, case-control study. The study reviewed case files of all patients diagnosed with rhino-orbito-cerebral mucormycosis (ROCM) from April 1, 2021, to May 31, 2021. A set of age-matched COVID-19-positive patients hospitalized during the study period with moderate to severe disease were recruited as controls. We addressed factors that could be associated with the development of fungal infection and studied the period between COVID-19 positivity and the onset of ROCM. Results The age of patients in both groups ranged from 40-60 years with 13 females and 17 males. A statistically significant correlation (p-value = 0.032) was found between positive reverse transcription-polymerase chain reaction (RT-PCR) history and use of intravenous (IV) corticosteroids (11 [73.3%] cases and all controls). The mean duration from COVID-19 positivity to the presentation of mucormycosis was 12.10±7.27 days. Uncontrolled blood sugar was found to be the most significant correlation (p-value = 0.003). Mucormycosis is 13.678 times more likely in people with abnormal hemoglobin A1c (HbA1c). Co-morbidities like anemia, chronic kidney disease (CKD), coronary artery disease (CAD), and leukemia were found in controls, but none of these conditions were seen in patients who developed mucormycosis. Conclusion Judicious use of steroids and strict control of blood sugar levels should be emphasized in the management of COVID-19 patients.
引言与目的
毛霉病是一种由毛霉菌引起的罕见但严重的血管侵袭性感染，主要影响免疫功能低下的人群或已感染其他疾病的患者。可怕的毛霉病感染最近因在冠状病毒病（COVID-19）和/或COVID-19后患者中夺走许多生命而声名狼藉。因此，人们感到有必要研究COVID-19患者中毛霉病的发展情况，以便在未来可能出现的疫情浪潮中更好地预防和治疗这种真菌感染。本研究还旨在确定COVID-19阳性、全身合并症以及治疗方式与鼻、鼻窦、眼眶和脑部发生视力威胁和生命威胁的毛霉感染可能性之间的关联。
方法
这是一项基于医院的回顾性病例对照研究。该研究回顾了2021年4月1日至2021年5月31日期间所有被诊断为鼻眶脑毛霉病（ROCM）的患者的病例档案。一组在研究期间因中度至重度疾病住院的年龄匹配的COVID-19阳性患者被招募为对照组。我们探讨了可能与真菌感染发展相关的因素，并研究了COVID-19阳性与ROCM发病之间的时间间隔。
结果
两组患者的年龄范围为40至60岁，其中女性13名，男性17名。在逆转录聚合酶链反应（RT-PCR）阳性病史与静脉注射（IV）皮质类固醇的使用之间发现了统计学上显著的相关性（p值 = 0.032）（11例[73.3%]病例和所有对照组）。从COVID-19阳性到出现毛霉病的平均持续时间为12.10±7.27天。发现血糖控制不佳是最显著的相关性（p值 = 0.003）。糖化血红蛋白（HbA1c）异常的人群患毛霉病的可能性是正常人的13.678倍。在对照组中发现了贫血、慢性肾脏病（CKD）、冠状动脉疾病（CAD）和白血病等合并症，但在发生毛霉病的患者中均未发现这些情况。
结论
在COVID-19患者的管理中，应强调谨慎使用类固醇和严格控制血糖水平。
