Thanjavur Sethuraman Karthigeyan, Athimanjeri Thiruvengadam Jayaraj, Ravichandran Abinaya, Thoppappatty Sengottaiyan Santhi
Institute of Internal Medicine, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India.
Curr Med Mycol. 2023 Sep;9(3):33-37. doi: 10.22034/cmm.2023.345154.1486.
India witnessed an explosive rise in mucormycosis following COVID-19 infection. Pulmonary mucormycosis closely followed rhino orbital mucormycosis as the most common presentation. The need for advanced resources and lack of clinical suspicion for COVID-19-associated pulmonary mucormycosis led to widespread underdiagnosis and poor response to late therapy. The present study aimed to assess the prevalence of pulmonary mucormycosis in COVID-19-associated rhino-orbital mucormycosis using non-invasive techniques, such as sputum microscopy and chest imaging.
A prospective observational study was conducted at the Institute of Internal Medicine, Rajiv Gandhi Government General Hospital in Chennai, India between June 2021 and July 2021. All hospitalized patients with proven rhino orbital mucormycosis with or without cerebral involvement within three months of confirmed COVID-19 infection who had clinical symptoms compatible with pulmonary mucormycosis were included in this study. These patients were screened for probable and possible COVID-19-associated pulmonary mucormycosis using computed tomography (CT) chest imaging and sputum microscopy within 48 h of hospital admission.
Based on the findings, 8 (16%) out of 50 patients with rhino-orbital mucormycosis, had associated possible or probable pulmonary mucormycosis. All 8 patients were diabetics and had characteristic CT chest findings while only half of them had positive sputum microscopy. A higher prevalence of probably disseminated COVID-19-associated mucormycosis was noted among 51-60-year-old males with the use of corticosteroids and oxygen for COVID-19 therapy. The mortality rate was 100% in probably disseminated mucormycosis, 50% in possible disseminated mucormycosis, and only 9.5% in isolated rhino-orbital mucormycosis.
Non-invasive and feasible methods, such as sputum microscopy and chest imaging can be considered for early screening and intensive management of probably disseminated mucormycosis to improve prognosis.
印度在新冠病毒感染后毛霉菌病呈爆发式增长。肺毛霉菌病紧随鼻眶毛霉菌病，成为最常见的表现形式。由于对新冠病毒相关肺毛霉菌病缺乏先进资源且临床怀疑不足，导致广泛的漏诊以及对晚期治疗反应不佳。本研究旨在使用痰涂片镜检和胸部影像学等非侵入性技术评估新冠病毒相关鼻眶毛霉菌病中肺毛霉菌病的患病率。
2021年6月至2021年7月，在印度钦奈的拉吉夫·甘地政府综合医院内科进行了一项前瞻性观察研究。所有在确诊新冠病毒感染后三个月内患有经证实的鼻眶毛霉菌病且有或无脑部受累、伴有与肺毛霉菌病相符临床症状的住院患者纳入本研究。这些患者在入院48小时内使用计算机断层扫描（CT）胸部成像和痰涂片镜检筛查可能的和疑似的新冠病毒相关肺毛霉菌病。
根据研究结果，50例鼻眶毛霉菌病患者中有8例（16%）伴有可能或疑似的肺毛霉菌病。所有8例患者均为糖尿病患者，胸部CT有特征性表现，而其中只有一半痰涂片镜检呈阳性。在使用皮质类固醇和氧气进行新冠病毒治疗的51至60岁男性中，疑似播散性新冠病毒相关毛霉菌病的患病率更高。疑似播散性毛霉菌病的死亡率为100%，可能播散性毛霉菌病为50%，孤立性鼻眶毛霉菌病仅为9.5%。
痰涂片镜检和胸部成像等非侵入性且可行的方法可用于疑似播散性毛霉菌病的早期筛查和强化管理，以改善预后。
