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新冠后毛霉菌病——概念性病因及新的治疗选择

Post-COVID Mucormycosis-Conceptual Etiology and New Treatment Options.

作者信息

Bavishi Maitree, Thomas Shaji, Nair Preeti Parmeswaran, Bavishi Prakashchandra, Masariya Bhavinkumar Dineshchandra

机构信息

Gujarat Cancer Research Centre (GCRI), Ahmedabad, India.

Bavishi Oral and Maxillofacial Hospital, Anand, Gujarat 388001 India.

出版信息

J Maxillofac Oral Surg. 2024 Dec;23(6):1516-1527. doi: 10.1007/s12663-024-02124-5. Epub 2024 May 16.

Abstract

INTRODUCTION

Coronavirus disease 2019 (COVID-19) has caused a massive pandemic in world. It is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and is also a doorway for other opportunistic bacterial and fungal infections. Mucormycosis is strongly connected with patients suffering from COVID-19 disease. The major factors attributed are steroid induced immunosuppression; systemic disorders especially diabetes mellitus, hypoxia, and metabolic acidosis.

AIMS AND OBJECTIVES

Unusual presentations of post-COVID mucormycosis in young patients without diabetes mellitus were observed. The new concept focuses on pathophysiology of the post-COVID mucormycosis which might involve other factors of coagulopathy and microembolism of vessels which provides a niche for fungal infection to invade in patients.

RESULTS

The new concept of treating post Covid mucormycosis by combining the anti-fungal drugs along with fibrinolytic agents reduces the microcoagulopathy, increases the recovery rate and healing of the mucormycosis.

CONCLUSIONS

Based on the clinical and application of scientific knowledge, this concept paper focuses on new hypothesis and treatment plans of post-COVID mucormycosis and an attempt to explain the difference between conventional mucormycosis and post-COVID mucormycosis.

摘要

引言

2019年冠状病毒病(COVID-19)已在全球引发大规模疫情。它由严重急性呼吸综合征冠状病毒2(SARS-CoV-2)引起,也是其他机会性细菌和真菌感染的入口。毛霉菌病与COVID-19疾病患者密切相关。主要归因因素包括类固醇诱导的免疫抑制;全身性疾病,尤其是糖尿病、缺氧和代谢性酸中毒。

目的

观察到无糖尿病的年轻患者中COVID后毛霉菌病的不寻常表现。新观念聚焦于COVID后毛霉菌病的病理生理学,这可能涉及凝血障碍和血管微栓塞的其他因素,为真菌感染在患者体内侵袭提供了一个生态位。

结果

将抗真菌药物与纤溶药物联合治疗COVID后毛霉菌病的新观念可减少微凝血障碍,提高毛霉菌病的恢复率和治愈率。

结论

基于临床和科学知识的应用,本概念文件聚焦于COVID后毛霉菌病的新假说和治疗方案,并试图解释传统毛霉菌病与COVID后毛霉菌病之间的差异。

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