Raychaudhuri Sujata, Taneja Juhi, Sasidharan Jaseetha, Pujani Mukta, Singh Kanika, Chatterjee Tathagata, Jain Manjula, Chandoke Rajkumar, Rai Anil, Abbas Zafar, Das Asim
Department of Pathology, ESIC Medical College and Hospital Faridabad, India.
Department of Microbiology, ESIC Medical College and Hospital, Faridabad, India.
Curr Med Mycol. 2023 Mar;9(1):1-7. doi: 10.18502/CMM.2023.150667.
Morbidity and mortality of opportunistic fungal infections in COVID-19 patients are less studied and defined. The patients receiving immunosuppressive therapy, broad-spectrum antibiotics, corticosteroids, and invasive and non-invasive ventilation are the high-risk groups.
The demographic profile as well as clinical and radiological findings of all the patients with COVID-19 suspected of Mucormycosis (MM) were recorded. The tissue samples from all the patients were sent for microbiological (KOH mount and culture) and histopathological analysis for confirmation of MM.
In total, 45 COVID-19 patients suspected of MM were included in the study and MM was confirmed in 42 patients. The mean age of the patients was 50.30±14.17 years with a female: male ratio of 1.1:1. The most common symptom was headache (52.38%) followed by purulent nasal discharge (38.09%) and facial pain in 33.33% of the cases. The ocular symptoms included a diminution of vision (33.33%) and redness of the eye (2.38%). The most common site of involvement was rhino-orbital (42.85%) followed by sinonasal (23.80%) and rhino cerebral (19.04%). Majority (38.09%) of the patients were diagnosed with stage II of Rhino-orbital-cerebral Mucormycosis (ROCM) based on radiology. A history of diabetes mellitus and steroids was present in 97.61% and 85.71% of the cases, respectively. Moreover, KOH was positive for MM in 97.61% of the cases while the culture was positive in only 35.71% of the cases. In addition, on histopathology, MM was confirmed in 64.28 % of the cases. Mixed growth with species and species was observed in 14.28% of the cases in culture and 11.90% of the cases in histopathology test. Furthermore, angioinvasion was found in 23.80% of the cases according to the histopathology test.
Based on the results, the most common conditions associated with MM in COVID-19 patients were diabetes mellitus and steroid therapy. A high level of clinical suspicion aided with diagnostic tests, including KOH mount, culture, histopathology, and radiology which helped the early detection of opportunistic fungal infection in COVID-19 patients to ensure timely treatment.
新型冠状病毒肺炎（COVID-19）患者机会性真菌感染的发病率和死亡率研究较少且定义不明确。接受免疫抑制治疗、广谱抗生素、皮质类固醇以及有创和无创通气的患者是高危人群。
记录所有疑似毛霉菌病（MM）的COVID-19患者的人口统计学资料以及临床和影像学检查结果。将所有患者的组织样本送去进行微生物学检查（氢氧化钾涂片和培养）以及组织病理学分析，以确诊MM。
本研究共纳入45例疑似MM的COVID-19患者，其中42例确诊为MM。患者的平均年龄为50.30±14.17岁，女性与男性比例为1.1:1。最常见的症状是头痛（52.38%），其次是脓性鼻涕（38.09%），33.33%的病例有面部疼痛。眼部症状包括视力下降（33.33%）和眼红（2.38%）。最常受累的部位是鼻眶部（42.85%），其次是鼻窦部（23.80%）和鼻脑部（19.04%）。根据影像学检查，大多数（38.09%）患者被诊断为鼻眶脑型毛霉菌病（ROCM）II期。分别有97.61%和85.71%的病例有糖尿病和使用类固醇的病史。此外，97.61%的病例氢氧化钾涂片MM呈阳性，而培养仅35.71%呈阳性。另外，组织病理学检查确诊MM的病例占64.28%。培养中14.28%的病例和组织病理学检查中11.90%的病例观察到有 种和 种的混合生长。此外，根据组织病理学检查，23.80%的病例发现有血管侵袭。
根据研究结果，COVID-19患者中与MM相关的最常见情况是糖尿病和类固醇治疗。高度的临床怀疑辅以诊断检查，包括氢氧化钾涂片、培养、组织病理学和影像学检查，有助于早期发现COVID-19患者的机会性真菌感染，以确保及时治疗。
