B H Shrikrishna, Kumbhalkar Sunita, Selvi Kalai, G Deepa, Bidkar Vijay, Dabhekar Sandeep, Prathipati Kirankumar, Sawal Anupama
Otolaryngology - Head and Neck Surgery, All India Institute of Medical Sciences, Bibinagar, Hyderabad, IND.
General Medicine, All India Institute of Medical Sciences, Nagpur, Nagpur, IND.
Cureus. 2023 Jul 30;15(7):e42674. doi: 10.7759/cureus.42674. eCollection 2023 Jul.
Background Mucormycosis is a consequence of the angioinvasive disease caused by filamentous fungi that belong to the order Mucorales, particularly , , and . is the most prevalent form. The invading hyphae lead to damage of blood vessels leading to thrombosis and consequent tissue necrosis. The incidence of this disease entity witnessed a significant rise during the second wave of the coronavirus disease 2019 (COVID-19) pandemic. Timely diagnosis and prompt treatment are crucial to diminish both the mortality and morbidity associated with this disease. Imaging plays a pivotal role in diagnosing the ailment, evaluating its extent, identifying complications such as thrombosis, and facilitating surgical planning. It demonstrates exceptional sensitivity in detecting the disease at its early stages, often before symptoms manifest. Due to the angioinvasive nature of , early detection assumes utmost importance as it necessitates intensive antifungal therapy and the removal of devitalized tissue through debridement. Methodology We conducted a retrospective cohort study to analyze computed tomography (CT) imaging findings in patients with COVID-associated rhino-orbito-cerebral mucormycosis (ROCM) confirmed by histopathological examination. We compared these findings with CT findings of the nose and paranasal sinuses in patients without mucor following COVID-19 sinusitis (non-ROCM). Results All 16 cases in the non-ROCM group were in stage 1 disease. In contrast, in the ROCM group, three patients had stage 1 disease, five patients had stage 2 disease, and 10 patients had stage 3 disease (p = 0.0001). The pterygopalatine fossa was significantly affected in 10 of 18 ROCM patients and in none of the non-ROCM patients. Conclusions Imaging plays a crucial role in the early detection of mucormycosis. It assists treating physicians in initiating prompt and aggressive treatment, thereby improving the prognosis of this frequently fatal disease.
背景 毛霉病是由属于毛霉目丝状真菌引起的血管侵袭性疾病的后果，尤其是毛霉属、根霉属和犁头霉属。鼻眶脑型毛霉病是最常见的形式。侵入的菌丝会导致血管损伤，进而导致血栓形成和随后的组织坏死。在2019冠状病毒病（COVID-19）大流行的第二波期间，这种疾病实体的发病率显著上升。及时诊断和迅速治疗对于降低与该疾病相关的死亡率和发病率至关重要。影像学在诊断该疾病、评估其范围、识别诸如血栓形成等并发症以及促进手术规划方面发挥着关键作用。它在疾病早期阶段，通常在症状出现之前，具有极高的检测敏感性。由于毛霉病的血管侵袭性，早期检测至关重要，因为这需要强化抗真菌治疗并通过清创术清除失活组织。方法 我们进行了一项回顾性队列研究，以分析经组织病理学检查确诊的COVID相关鼻眶脑型毛霉病（ROCM）患者的计算机断层扫描（CT）影像学表现。我们将这些表现与COVID-19鼻窦炎（非ROCM）后无毛霉病患者的鼻和鼻窦CT表现进行了比较。结果 非ROCM组的所有16例患者均处于1期疾病。相比之下，ROCM组中，3例患者处于1期疾病，5例患者处于2期疾病，10例患者处于3期疾病（p = 0.0001）。18例ROCM患者中有10例翼腭窝受到显著影响，而非ROCM患者中无一例出现这种情况。结论 影像学在毛霉病的早期检测中起着关键作用。它有助于治疗医生启动及时且积极的治疗，从而改善这种常致命疾病的预后。
