Chillana Suchira, Mohit Chilana Kapil Alias
Department of Microbiology, NC Medical College and Hospital, Israna, Haryana, India.
Department of Respiratory Medicine, Kalpana Chawla Government Medical College, Karnal, Haryana, India The work was conducted at Kalpana Chawla Government Medical College, Haryana, India.
Indian J Dermatol. 2022 Sep-Oct;67(5):535-538. doi: 10.4103/ijd.ijd_17_22.
Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been associated with a wide range of opportunistic bacterial and fungal infections. Recently, several cases of mucormycosis in people with COVID-19 have been increasingly reported worldwide, in particular in India. 1. To study the total prevalence of mucormycosis and other fungal species in patients' samples. 2. To elaborate on the associated underlying risk factors and their presentations with COVID-19. The study was conducted at the Department of Microbiology, Kalpana Chawla Government Medical College from April 2021 to July 2021 during the COVID-19 pandemic. Both outpatient and admitted cases were included in the study suspected of mucormycosis with underlying COVID-19 infection or post-recovery phase. In total, 906 nasal swab samples were collected at the time of the visit from suspected patients and were sent to the microbiology laboratory of our institute for processing. Both microscopic examinations by preparing a wet mount with KOH and lactophenol cotton blue stain and culture using Sabouraud's dextrose agar (SDA) were done. Subsequently, we analyzed the patient's clinical presentations at a hospital, associated comorbidities, site of mucormycosis infection, past history for use of steroids or oxygen therapy, admissions required, and its outcome in patients with COVID-19. In total, 906 nasal swabs from suspected cases of mucormycosis in people with COVID-19 were processed. In all, 451 (49.7%) fungal positivity was seen, out of which 239 (26.37%) were mucormycosis. Other fungi such as (175, 19.3%), 28 (3.1%), (6, 0.66%) and (0.11%) were also identified. Out of the total, 52 were mixed infections. The total percentage of patients having underlying active COVID-19 infection or in the post-recovery phase was 62%. Most cases (80%) were of rhino-orbital origin, 12% were Pulmonary and the rest 8% where no primary site of infection was confirmed. Among risk factors, pre-existing diabetes mellitus (DM), or acute hyperglycemia was present in 71% of cases. Corticosteroid intake was recorded in 68% of cases, chronic hepatitis infection in 4%, two cases of chronic kidney disease, and only one case with triple infection of COVID-19, underlying HIV, and pulmonary tuberculosis. Death from fungal infection was reported in 28.7% of the cases. Even with rapid diagnosis, treatment of underlying disease, and aggressive medical and surgical intervention, the management is often not effective, leading to an extension of the infection and ultimately death. So, early diagnosis and prompt management of this suspected new emerging fungal infection with COVID-19 should be considered.
由严重急性呼吸综合征冠状病毒2（SARS-CoV-2）引起的2019冠状病毒病（COVID-19）与多种机会性细菌和真菌感染有关。最近，全球范围内越来越多地报告了COVID-19患者发生毛霉菌病的病例，尤其是在印度。1. 研究患者样本中毛霉菌病和其他真菌种类的总患病率。2. 详细阐述与COVID-19相关的潜在危险因素及其表现。该研究于2021年4月至2021年7月在卡尔帕娜·乔拉政府医学院微生物学系进行，当时正处于COVID-19大流行期间。研究纳入了疑似患有毛霉菌病且伴有潜在COVID-19感染或康复期的门诊和住院病例。总共在就诊时从疑似患者处采集了906份鼻拭子样本，并送往我院微生物实验室进行处理。同时进行了通过用氢氧化钾和石炭酸棉蓝染色制备湿片进行显微镜检查以及使用沙氏葡萄糖琼脂（SDA）进行培养。随后，我们分析了患者在医院的临床表现、相关合并症、毛霉菌病感染部位、既往使用类固醇或氧疗的病史、所需住院情况以及COVID-19患者的治疗结果。总共对906份COVID-19患者疑似毛霉菌病病例的鼻拭子进行了处理。总共发现451份（49.7%）真菌阳性，其中239份（26.37%）为毛霉菌病。还鉴定出了其他真菌，如（175份，19.3%）、28份（3.1%）、（6份，0.66%）和（0.11%）。其中，52份为混合感染。患有潜在活动性COVID-19感染或处于康复期的患者总比例为62%。大多数病例（80%）起源于鼻眶部，12%为肺部感染，其余8%未确认主要感染部位。在危险因素中，71%的病例存在既往糖尿病（DM）或急性高血糖。68%的病例记录有皮质类固醇摄入，4%的病例有慢性肝炎感染，2例有慢性肾病，仅有1例为COVID-19、潜在HIV和肺结核的三重感染。2 .7%的病例报告死于真菌感染。即使进行快速诊断、治疗基础疾病以及积极的药物和手术干预，治疗往往也无效，导致感染扩散并最终死亡。因此，应考虑对这种疑似与COVID-19相关的新出现真菌感染进行早期诊断和及时处理。
