Ahmadkhani Fardin, Hashemi Seyed Jamal, Daei Ghazvini Roshanak, Salehi Mohammadreza, Tabari Azin, Alcazar-Fuoli Laura, Pakdel Farzad, Abdollahi Alireza, Firouzifar Mohammadreza, Moradi Masoud, Khodavaisy Sadegh
Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Research Center for Antibiotic Stewardship and Antimicrobial Resistance, Department of Infectious Diseases and Tropical Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
Iran J Pathol. 2025 Summer;20(3):288-296. doi: 10.30699/ijp.2025.2044252.3371. Epub 2025 Jul 1.
BACKGROUND & OBJECTIVE: Mucormycosis has emerged as a severe complication in COVID-19 patients, particularly among those with uncontrolled diabetes and those receiving corticosteroid therapy. The infection's tendency to spread from the sinuses to the orbit and central nervous system (CNS) significantly increases morbidity and mortality. This study aimed to identify clinical risk factors and outcomes associated with disease severity and mortality in COVID-19-associated mucormycosis (CAM), with a focus on disease progression to orbital and CNS involvement.
A total of 180 confirmed CAM patients were enrolled and classified into three groups based on disease extent: sinus-only, sinus with orbital involvement, and sinus with both orbital and CNS involvement. Data were collected on demographics, clinical history, laboratory findings, imaging results, treatment modalities, and outcomes.
Of the 180 patients, 63.3% had sinus-only involvement, 23.9% had sinus and orbital involvement, and 12.8% had sinus, orbital, and CNS involvement. Uncontrolled diabetes was observed in 38% of patients and was more prevalent in those with extensive disease. Corticosteroid use was significantly associated with disease severity ( = 0.002). Invasive procedures, such as orbital exenteration, were significantly linked to CNS progression ( < 0.05). The overall mortality rate was 31% (55 of 180 patients).
Uncontrolled diabetes and corticosteroid therapy are major risk factors for severe CAM. Extension of mucormycosis beyond the sinuses, particularly to the orbit and CNS, is associated with poor clinical outcomes and often requires aggressive surgical management. Early diagnosis and prompt intervention are essential to improve survival in these patients.
毛霉病已成为新冠肺炎患者的一种严重并发症，尤其是在糖尿病控制不佳和接受糖皮质激素治疗的患者中。感染从鼻窦扩散至眼眶和中枢神经系统（CNS）的倾向显著增加了发病率和死亡率。本研究旨在确定与新冠肺炎相关毛霉病（CAM）的疾病严重程度和死亡率相关的临床危险因素及预后，重点关注疾病进展至眼眶和中枢神经系统受累情况。
共纳入180例确诊的CAM患者，并根据疾病范围分为三组：仅累及鼻窦组、累及鼻窦伴眼眶组、累及鼻窦伴眼眶及中枢神经系统组。收集了患者的人口统计学、临床病史、实验室检查结果、影像学结果、治疗方式及预后等数据。
180例患者中，63.3%仅累及鼻窦，23.9%累及鼻窦和眼眶，12.8%累及鼻窦、眼眶及中枢神经系统。38%的患者存在糖尿病控制不佳的情况，且在疾病广泛的患者中更为常见。使用糖皮质激素与疾病严重程度显著相关（P = 0.002）。诸如眼眶内容物剜除术等侵入性操作与中枢神经系统进展显著相关（P < 0.05）。总死亡率为31%（180例患者中有55例）。
糖尿病控制不佳和糖皮质激素治疗是严重CAM的主要危险因素。毛霉病超出鼻窦范围，尤其是累及眼眶和中枢神经系统，与不良临床预后相关，且通常需要积极的手术治疗。早期诊断和及时干预对于改善这些患者的生存率至关重要。
