Department of Medicine, King George's Medical University, Lucknow, India.
Department of Neurology, King George's Medical University, Lucknow, India.
Mycopathologia. 2024 Jun 12;189(4):54. doi: 10.1007/s11046-024-00859-w.
During the COVID-19 pandemic-associated mucor epidemic, acute antifungal drug shortage necessitated the exploration of other antifungals based on culture sensitivity. Itraconazole is a cheap, safe, and effective antifungal in sensitive cases.
We enrolled itraconazole-sensitive COVID-19-associated mucormycosis during the mucormycosis pandemic. After the intensive phase course of liposomal amphotericin B, Itraconazole was offered in susceptible cases during the maintenance phase along with standard of care. These patients were clinically and radiologically followed for 6 months.
We enrolled 14 patients (Male: Female-11:3) of Rhino-orbito-cerebral mucormycosis (ROCM) which included 12 diabetics. All patients had facial swelling, orbital swelling, visual impairment, and headache. MRI showed involvement of bilateral sinus (10/14), orbital extension (13/14), cavernous sinus (5/14), cerebral part of the internal carotid artery (3/14), and brain infarcts (4/14). All 14 patients showed sensitivity to Itraconazole with 12 having minimum inhibitory concentration (MIC) ≤ 1 μg/ml and 2 having MIC ≤ 2 μg/ml. Follow-up at 6 months showed clinical improvement in the majority (11/14) and radiological improvement in six out of seven scanned patients.
Our study shows the potential therapeutic role of oral Itraconazole in ROCM.
在 COVID-19 大流行相关的毛霉病流行期间，急性抗真菌药物短缺促使我们根据培养敏感性探索其他抗真菌药物。在敏感病例中，伊曲康唑是一种廉价、安全且有效的抗真菌药物。
我们招募了 COVID-19 相关毛霉病中对伊曲康唑敏感的患者。在两性霉素 B 脂质体强化治疗阶段后，在维持治疗阶段，我们为敏感病例提供伊曲康唑，并结合标准治疗。这些患者接受了 6 个月的临床和影像学随访。
我们共招募了 14 例（男：女 11：3）鼻-眶-脑毛霉病（ROCM）患者，其中包括 12 例糖尿病患者。所有患者均有面部肿胀、眶周肿胀、视力障碍和头痛。MRI 显示双侧窦（10/14）、眶内延伸（13/14）、海绵窦（5/14）、颈内动脉颅内段（3/14）和脑梗死（4/14）受累。14 例患者均对伊曲康唑敏感，其中 12 例最低抑菌浓度（MIC）≤1μg/ml，2 例 MIC≤2μg/ml。6 个月随访时，大多数患者（11/14）临床症状改善，7 例接受影像学检查的患者中有 6 例影像学改善。
我们的研究表明，口服伊曲康唑在 ROCM 中有潜在的治疗作用。
