Division of Infectious Disease, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Internal Medicine, National Yang Ming Chao Tung University, Taipei, Taiwan.
Division of Infectious Diseases, Department of Medicine, MacKay Memorial Hospital, Taipei, Taiwan; MacKay Medical College, New Taipei City, Taiwan.
J Microbiol Immunol Infect. 2023 Jun;56(3):442-454. doi: 10.1016/j.jmii.2022.12.004. Epub 2022 Dec 15.
COVID-19-associated mold infection (CAMI) is defined as development of mold infections in COVID-19 patients. Co-pathogenesis of viral and fungal infections include the disruption of tissue barrier following SARS CoV-2 infection with the damage in the alveolar space, respiratory epithelium and endothelium injury and overwhelming inflammation and immune dysregulation during severe COVID-19. Other predisposing risk factors permissive to fungal infections during COVID-19 include the administration of immune modulators such as corticosteroids and IL-6 antagonist. COVID-19-associated pulmonary aspergillosis (CAPA) and COVID-19-associated mucormycosis (CAM) is increasingly reported during the COVID-19 pandemic. CAPA usually developed within the first month of COVID infection, and CAM frequently arose 10-15 days post diagnosis of COVID-19. Diagnosis is challenging and often indistinguishable during the cytokine storm in COVID-19, and several diagnostic criteria have been proposed. Development of CAPA and CAM is associated with a high mortality despiteappropriate anti-mold therapy. Both isavuconazole and amphotericin B can be used for treatment of CAPA and CAM; voriconazole is the primary agent for CAPA and posaconazole is an alternative for CAM. Aggressive surgery is recommended for CAM to improve patient survival. A high index of suspicion and timely and appropriate treatment is crucial to improve patient outcome.
COVID-19 相关霉菌感染（CAMI）定义为 COVID-19 患者发生霉菌感染。病毒和真菌感染的共同发病机制包括 SARS CoV-2 感染后组织屏障的破坏，肺泡空间、呼吸上皮和血管内皮损伤，以及 COVID-19 重症患者中炎症和免疫失调的失控。COVID-19 期间允许真菌感染的其他诱发危险因素包括免疫调节剂的使用，如皮质类固醇和 IL-6 拮抗剂。在 COVID-19 大流行期间，越来越多的报道称 COVID-19 相关肺曲霉病（CAPA）和 COVID-19 相关毛霉菌病（CAM）。CAPA 通常在 COVID 感染后的第一个月内发展，而 CAM 通常在 COVID-19 诊断后 10-15 天发生。在 COVID-19 的细胞因子风暴期间，诊断具有挑战性，通常难以区分，已经提出了几种诊断标准。尽管进行了适当的抗霉菌治疗，但 CAPA 和 CAM 的发展仍与高死亡率相关。伊曲康唑和两性霉素 B 均可用于治疗 CAPA 和 CAM；伏立康唑是 CAPA 的主要药物，泊沙康唑是 CAM 的替代药物。建议对 CAM 进行积极手术以提高患者生存率。高度怀疑、及时和适当的治疗对于改善患者预后至关重要。
