COVID-19 相关毛霉菌病：69 例患者的单中心观察性研究。

Coronavirus Disease-19-associated Mucormycosis: A Single-center Observational Study of 69 Patients.

机构信息

Assistant Professor, Department of Medicine, Lokmanya Tilak Municipal General Hospital and Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India.

Professor, Department of Medicine, Lokmanya Tilak Municipal General Hospital and Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India.

出版信息

J Assoc Physicians India. 2024 Oct;72(10):24-31. doi: 10.59556/japi.72.0684.

DOI:10.59556/japi.72.0684

PMID:39390855

Abstract

BACKGROUND AND OBJECTIVES

We studied the clinical presentation, risk factors, complications, and in-hospital outcomes of patients with coronavirus disease 2019 (COVID-19)-associated mucormycosis (CAM).

MATERIALS AND METHODS

A retrospective study was done on 69 COVID-19 patients with microbiologically proven mucormycosis admitted over a period of seven months from March 2021 to September 2021.

RESULTS

All 69 mucormycosis patients (46 males, 23 females) had reverse transcriptase-polymerase chain reaction (RT-PCR)-confirmed COVID-19 infection. Their mean age was 52.8 years, with mucormycosis developing in 51 patients (73.9%) within 30 days of COVID-19 infection; 7 (10.1%) were positive on admission. Rhino-orbital-cerebral mucormycosis (ROCM) was the most common (40.3%), followed by rhino-orbital (37.3%) and sinonasal (22.4%). Diabetes mellitus was present in 98.6% of patients. Common symptoms of mucormycosis were facial pain, headache, facial swelling, and vision loss. During COVID-19, 88.4 and 52.5% received immunosuppressive treatment and zinc sulfate, respectively; 34.7% needed intensive care unit (ICU) admission. The mortality rate was 26.1%. On multivariate logistic regression analysis, the presence of chronic kidney disease, leukocytosis, ophthalmoplegia, oral/palate ulceration, current need for invasive ventilation, and past duration of oxygen therapy and zinc supplementation were significantly associated with mortality. Patients with current COVID-19 infection had severe disease with increased need for intensive care (57.1 vs 14.5%) and higher mortality (57.1 vs 22.6%) compared to mucormycosis patients with previous COVID-19 infection.

INTERPRETATION AND CONCLUSION

Rhino-orbital-cerebral, rhino-orbital, and sinonasal were the most common presentations in cases of mucormycosis, with a mortality rate of 26.1%. COVID-19 coinfection predisposes patients with mucormycosis to severe disease with higher mortality.

摘要

背景与目的

我们研究了与 2019 年冠状病毒病（COVID-19）相关的毛霉菌病（CAM）患者的临床表现、危险因素、并发症和住院期间结局。

材料与方法

对 2021 年 3 月至 9 月期间 7 个月内确诊为 COVID-19 合并微生物学证实毛霉菌病的 69 例 COVID-19 患者进行回顾性研究。

结果

69 例毛霉菌病患者（男 46 例，女 23 例）均经逆转录聚合酶链反应（RT-PCR）证实 COVID-19 感染。平均年龄为 52.8 岁，51 例（73.9%）在 COVID-19 感染后 30 天内发生毛霉菌病；入院时阳性者 7 例（10.1%）。最常见的是鼻-眶-脑毛霉菌病（ROCM）（40.3%），其次是鼻-眶（37.3%）和鼻-鼻窦（22.4%）。98.6%的患者患有糖尿病。毛霉菌病的常见症状为面部疼痛、头痛、面部肿胀和视力丧失。COVID-19 期间，分别有 88.4%和 52.5%的患者接受了免疫抑制治疗和硫酸锌治疗；34.7%需要入住重症监护病房（ICU）。死亡率为 26.1%。多变量 logistic 回归分析显示，存在慢性肾脏病、白细胞增多、眼肌麻痹、口腔/腭溃疡、目前需要有创通气、以及过去吸氧和锌补充的时间与死亡率显著相关。与既往 COVID-19 感染的毛霉菌病患者相比，目前存在 COVID-19 感染的患者疾病更严重，需要更多的重症监护（57.1% vs 14.5%）和更高的死亡率（57.1% vs 22.6%）。