Chopra Shivya, Setiya Sneha, Waknis Pushkar P, Kale Luke, Tidke Sanika
Department of Oral and Maxillofacial Surgery, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pimpri, Pune, India.
J Maxillofac Oral Surg. 2023 Mar 13:1-22. doi: 10.1007/s12663-023-01878-8.
Mucormycosis emerged as a wildfire in post-covid-19 infected patients. Most frequently involved sites of mucormycosis are rhino-orbital, rhino-sinusal and rhino-orbito-cerebral. The hallmark sign of mucormycosis is tissue necrosis, which is often a late sign. The fatality rate of mucormycosis is 46% globally. Despite early aggressive combined surgical and medical therapy, the prognosis of mucormycosis is poor.
We searched the electronic database of PubMed, web of science, Embase, Scopus and Google Scholar from Jan 2020 until December 2021 using keywords. We retrieved all the granular details of original research articles, case reports/series of patients with rhino-orbito-cerebral mucormycosis (ROCM), and COVID-19 reported worldwide. Subsequently, we analyzed the patient characteristics, associated comorbidities, location of mucormycosis, treatment given and its outcome in people with COVID-19. (Prospero registration-CRD42021256830, June 4, 2021).
Overall, 544 rhino-orbito-cerebral mucormycosis patients were included in our review with a history of Covid-19 infection. Out of which 410 patients had diabetes mellitus which has proven to be major contributing immunocompromised disease. Other diseases like hypertension, chronic kidney diseases, hypothyroidism, etc., were also attributed as an immunocompromised disease causing increased number of covid associated mucormycosis cases. We found out that total number of patients alive after taking only antifungal drug treatment were 25 in number, whereas total number of patients alive when antifungal drugs were combined with surgical intervention were 428 which was significantly higher.
Our systematic review concluded that surgical debridement should be performed whenever feasible in parallel to antifungal treatment in order to reduce the mortality rate of COVID-19 associated rhino-orbito-cerebral mucormycosis patients.
毛霉病在新冠肺炎感染患者中如野火般爆发。毛霉病最常累及的部位是鼻眶、鼻窦和鼻眶脑。毛霉病的标志性体征是组织坏死，这通常是晚期体征。毛霉病的全球死亡率为46%。尽管早期采取积极的手术和药物联合治疗，但毛霉病的预后仍然很差。
我们使用关键词搜索了2020年1月至2021年12月期间的PubMed、科学网、Embase、Scopus和谷歌学术电子数据库。我们检索了全球范围内报告的所有关于鼻眶脑毛霉病（ROCM）和新冠肺炎的原始研究文章、病例报告/系列患者的详细信息。随后，我们分析了新冠肺炎患者的特征、相关合并症、毛霉病的发病部位、所给予的治疗及其结果。（国际前瞻性系统评价注册平台注册号-CRD42021256830，2021年6月4日）。
总体而言，我们的综述纳入了544例有新冠肺炎感染史的鼻眶脑毛霉病患者。其中410例患有糖尿病，这已被证明是主要的免疫功能低下相关疾病。其他疾病如高血压、慢性肾脏病、甲状腺功能减退等，也被认为是导致新冠肺炎相关毛霉病病例增加的免疫功能低下疾病。我们发现，仅接受抗真菌药物治疗后存活的患者有25例，而抗真菌药物与手术干预联合治疗后存活的患者有428例，后者显著更高。
我们的系统评价得出结论，在治疗新冠肺炎相关鼻眶脑毛霉病患者时，应在可行的情况下与抗真菌治疗同时进行手术清创，以降低死亡率。
