印度三级保健中心第二波COVID-19期间毛霉菌病的临床概况

Sunil Kumar Kunhiparambath, B. Oommen, Sajeeth Kumar Keeriyatt Govindan, K. S. Nair, Sagesh Madayambath
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引用次数: 1

摘要

目的:研究新冠肺炎第二波疫情并发毛霉菌病的临床特点和治疗效果。方法:在三级护理中心进行为期12个月的观察性研究,包括6个月的治疗后随访。这项研究包括了在第二波新冠肺炎期间有鼻-脑毛霉菌病临床和放射学证据的所有新冠肺炎阳性患者。所有患者都接受了进一步的诊断检查,确诊病例接受了手术清创术,并开始使用两性霉素B。结果:59例患者出现毛霉菌病,平均年龄52.7岁,最常见症状为单侧面部和眼眶水肿(28.8%),所有患者均为糖尿病,HbA1c>7(54.2%),自新冠肺炎感染开始平均出现时间为20.7±7.9天。单侧鼻窦受累是MRI中最常见的发现。所有病例都进行了两性霉素B的早期给药并及时进行手术清创。为了更好地清除真菌负荷,对9名患者进行了眼眶外泌术。患者对手术清创和及时治疗反应良好,死亡率为27%。结论:新冠肺炎相关毛霉菌病治疗困难,常出现在晚期。糖尿病失控、免疫功能低下和类固醇诱导的免疫抑制是重要的危险因素。必须对早期识别和开始治疗进行密切监测。反复进行外科清创术以清除坏死组织对控制真菌负荷是有效的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Clinical Profile of Mucormycosis during the Second Wave of COVID-19 in a Tertiary Care Center in India
Objective: To study the clinical profile and treatment outcome of mucormycosis associated with the second wave of COVID-19 pandemic.Methods: An observational study was conducted in a tertiary care center over a period of 12 months, including a 6-month post treatment follow up. Study included all COVID positive patients with a clinical and radiological evidence of rhino-orbito-cerebral mucormycosis during the second wave of COVID-19. All patients underwent further diagnostic workup and confirmed cases underwent surgical debridement and Amphotericin B was started.Results: A total of 59 patients presented with mucormycosis with the mean age being 52.7 years and unilateral facial and orbital edema as the most common symptoms (28.8%). All were diabetic with HbA1c >7 in 54.2%. The mean duration of presentation was 20.7±7.9 days from the onset of COVID-19 infection. Unilateral involvement of the paranasal sinuses was the most common finding in MRI. Early administration of Amphotericin B with prompt surgical debridement was performed in all cases. Orbital exenteration was conducted in nine patients for better fungal load clearance. Patients showed a good response to surgical debridement and prompt medical treatment, with a mortality rate of 27%.Conclusion: COVID-19 associated mucormycosis is difficult to treat and often presents in late stage. Uncontrolled diabetes, immunocompromised state, and steroid-induced immunosuppression were important risk factors. A close surveillance for early identification and initiation of treatment is mandatory. Repeated surgical debridement to clear the dead tissue is effective to control fungal load. 
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