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毛霉菌病的颅面部累及:来自伊朗设拉子的57例单中心经验

Craniofacial Involvement of Mucormycosis: A Single-Center Experience of 57 Cases From Shiraz, Iran.

作者信息

Naddaffard Darioush, Yousefi Omid, Farrokhi Amirmohammad, Adel Maryam, Jalali Mahtab, Yousefi Mina, Jalli Reza, Taheri Reza, Masoudi Mohammad Sadegh

机构信息

Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran.

Department of Radiology, Shiraz University of Medical Sciences, Shiraz, Iran.

出版信息

Can J Infect Dis Med Microbiol. 2025 Jul 30;2025:4780569. doi: 10.1155/cjid/4780569. eCollection 2025.


DOI:10.1155/cjid/4780569
PMID:40771402
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12328050/
Abstract

The incidence of mucormycosis surged significantly during the COVID-19 pandemic, particularly among patients with diabetes mellitus (DM), a history of corticosteroid use, or immunosuppression. In Iran, the heightened prevalence of this opportunistic fungal infection underscored the critical importance of timely and comprehensive treatment, encompassing both medical and surgical approaches. This article aims to analyze the characteristics, clinical presentations, and treatment regimens of mucormycosis patients in Iran. Data from 57 patients referred to Shiraz University of Medical Sciences, all with confirmed pathological cultures, were evaluated. Among these patients, 74% had pre-existing DM, and the most common symptom was periorbital edema (46%), followed by decreased visual acuity (28%). Amphotericin B was administered to 93% of the patients, while 75% received posaconazole. Surgical intervention was performed in 86% of the cases, primarily through functional endoscopic sinus surgery (FESS) (61%). Despite these efforts, the overall mortality rate was 26%. Mucormycosis emerged as a serious complication of COVID-19 in Iran. Therefore, clinicians should include it in the differential diagnosis, particularly for patients with comorbidities or a history of antibiotic or corticosteroid use, and promptly initiate antifungal treatment and surgical intervention during potential future outbreaks.

摘要

在新冠疫情期间,毛霉菌病的发病率显著飙升,尤其是在患有糖尿病、有使用皮质类固醇病史或免疫抑制的患者中。在伊朗,这种机会性真菌感染的高流行率凸显了及时和全面治疗的至关重要性,包括医学和外科治疗方法。本文旨在分析伊朗毛霉菌病患者的特征、临床表现和治疗方案。对转诊至设拉子医科大学的57例患者的数据进行了评估,所有患者均有确诊的病理培养结果。在这些患者中,74%患有糖尿病,最常见的症状是眶周水肿(46%),其次是视力下降(28%)。93%的患者接受了两性霉素B治疗,75%的患者接受了泊沙康唑治疗。86%的病例进行了手术干预,主要通过功能性鼻内镜鼻窦手术(FESS)(61%)。尽管采取了这些措施,总体死亡率仍为26%。在伊朗,毛霉菌病成为新冠疫情的一种严重并发症。因此,临床医生应将其纳入鉴别诊断,特别是对于有合并症或有抗生素或皮质类固醇使用史的患者,并在未来可能爆发疫情时及时启动抗真菌治疗和手术干预。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/efb2/12328050/4e101e967429/CJIDMM2025-4780569.001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/efb2/12328050/4e101e967429/CJIDMM2025-4780569.001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/efb2/12328050/4e101e967429/CJIDMM2025-4780569.001.jpg

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本文引用的文献

[1]
Features and evaluation of mucormycosis in COVID-19 patients from two referral hospitals in Iran.

J Mycol Med. 2024-6

[2]
COVID-19-associated fungal infections in Iran: A systematic review.

PLoS One. 2022

[3]
The emergence of COVID-19 associated mucormycosis: a review of cases from 18 countries.

Lancet Microbe. 2022-7

[4]
Dental and Oral Manifestations of COVID-19 Related Mucormycosis: Diagnoses, Management Strategies and Outcomes.

J Fungi (Basel). 2021-12-31

[5]
COVID-19-associated mucormycosis: Evidence-based critical review of an emerging infection burden during the pandemic's second wave in India.

PLoS Negl Trop Dis. 2021-11

[6]
COVID-19-Associated Mucormycosis (CAM): An Updated Evidence Mapping.

Int J Environ Res Public Health. 2021-9-30

[7]
COVID-19-associated mucormycosis: Case report and systematic review.

Travel Med Infect Dis. 2021

[8]
Clinical Presentations, Management and Outcomes of Rhino-Orbital-Cerebral Mucormycosis (ROCM) Following COVID-19: A Multi-Centric Study.

Ophthalmic Plast Reconstr Surg.

[9]
COVID-19 associated mucormycosis: the urgent need to reconsider the indiscriminate use of immunosuppressive drugs.

Ther Adv Infect Dis. 2021-6-18

[10]
Mucormycosis in COVID-19: A systematic review of cases reported worldwide and in India.

Diabetes Metab Syndr. 2021

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