Arora Nikhil, Goel Ashiya, Kumar Pratik, Bhargava Aditya
Department of Otorhinolaryngology, Pt B.D Sharma, PGIMS, Rohtak, Rohtak, Haryana, 124001 Haryana India.
Indian J Otolaryngol Head Neck Surg. 2023 Mar 28;75(3):1-7. doi: 10.1007/s12070-023-03707-3.
Covid-19 infection increases the risk of opportunistic infections like mucormycosis. Cutaneous mucormycosis can occur primarily by direct inoculation or secondary to involvement of the underlying structures. Cutaneous manifestations include tender, erythematous, indurated lesions and necrotic plaques. As the disease evolves, cutaneous features manifest progressively. To study the manifestations of the cutaneous signs of sinonasal mucormycosis and management of such cases based on severity of involvement. A retrospective analysis of 21 patients with diagnosis of cutaneous mucormycosis secondary to sinonasal involvement was done with assessment of their skin lesion, area involved and their clinical stage being noted at the time of admission and after 24 h. Treatment consisted of combination of surgical debridement, daily dressing and liposomal amphotericin B. Out of total 21 patients, there were 10 males and 11 females. Among risk factors, 14 cases had history of covid 19 infection, 5 had history of steroid intake, 6 had history of ICU stay and all had deranged blood sugar levels. Among disease prognosis, excellent outcomes appeared in stage I and stage III showed worst outcome. Since initial clinical presentation is similar to cellulitis and other soft-tissue infections, early recognition is difficult. In this cohort, the prognosis of secondary cutaneous mucormycosis remained poor, especially in ICU patients and those with numerous predisposing factors. Such patients presented in late stages of the disease and mortality rate was very high in such group.
新型冠状病毒肺炎(Covid-19)感染会增加诸如毛霉菌病等机会性感染的风险。皮肤毛霉菌病可主要通过直接接种发生,或继发于深部组织受累。皮肤表现包括压痛性、红斑性、硬结性损害和坏死性斑块。随着疾病进展,皮肤特征会逐渐显现。目的是研究鼻-鼻窦毛霉菌病皮肤表现以及根据受累严重程度对此类病例的处理。对21例诊断为继发于鼻-鼻窦受累的皮肤毛霉菌病患者进行回顾性分析,评估其皮肤损害、受累面积以及入院时和24小时后的临床分期。治疗包括手术清创、每日换药和脂质体两性霉素B联合应用。21例患者中,男性10例,女性11例。在危险因素中,14例有新型冠状病毒肺炎(Covid-19)感染史,5例有类固醇摄入史,6例有重症监护病房(ICU)住院史,且所有患者血糖水平均紊乱。在疾病预后方面,I期患者预后良好,III期患者预后最差。由于初始临床表现与蜂窝织炎和其他软组织感染相似,早期识别困难。在这一队列中,继发性皮肤毛霉菌病的预后仍然较差,尤其是在ICU患者和有众多易感因素的患者中。此类患者在疾病晚期就诊,该组死亡率非常高。