Clinical Phenotypes of COVID-19 Associated Mucormycosis (CAM): A Comprehensive Review

被引:7
作者
Almyroudi, Maria Panagiota [1 ]
Akinosoglou, Karolina [2 ]
Rello, Jordi [3 ]
Blot, Stijn [4 ,5 ]
Dimopoulos, George [6 ]
机构
[1] Natl & Kapodistrian Univ Athens, Univ Hosp Attikon, Med Sch, Dept Emergency Med, Athens 12462, Greece
[2] Univ Patras, Univ Gen Hosp Patras, Sch Med, Dept Internal Med & Infect Dis, Rion 26504, Greece
[3] CHU Nimes, Vall dHebron Inst Res, Spain & Clin Res, Barcelona, F-30900 Nimes, France
[4] Univ Ghent, Dept Internal Med & Pediat, B-9000 Ghent, Belgium
[5] Univ Queensland, Fac Med, UQ Ctr Clin Res, Brisbane 4029, Australia
[6] Natl & Kapodistrian Univ Athens, EVGENIDIO Hosp, Med Sch, Dept Crit Care 3, Athens 11528, Greece
关键词
mucorales; invasive fungal infections; SARS-CoV-2; diabetes mellitus; rhino-orbito-cerebral mucormycosis; ORBITAL-CEREBRAL MUCORMYCOSIS; COVID-19-ASSOCIATED MUCORMYCOSIS; CARE CENTER; MANAGEMENT; SPECTRUM; PROFILE;
D O I
10.3390/diagnostics12123092
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
A mucormycosis surge was reported during the COVID-19 pandemic in India. A literature search until 14 July 2022, with the aim of updating COVID-19-associated mucormycosis (CAM), identified 663 studies and 88 met inclusion criteria (8727 patients). India reported 8388 patients, Egypt 208 and Europe 40. Rhino-orbito-cerebral mucormycosis (ROCM) was identified among 8082 (98.3%) patients, followed by 98 (1.2%) with pulmonary. In India, 82.6% of patients had diabetes mellitus, with 82% receiving corticosteroids. In Europe, 75% presented pulmonary CAM, 32.5% had diabetes and 40% were immunocompromised. CAM was identified at a median of 17.4 days (IQR 7.5 days) post COVID-19 diagnosis, and PCR was performed in five studies. Rhino-orbital invasion is clinically obvious, while cerebral involvement presents with cavernous sinus thrombosis, meningitis and cerebrovascular disease. Symptoms of pulmonary CAM usually overlap with severe COVID-19 pneumonia. High-dose liposomal Amphotericin B (and early surgical debridement in ROCM) are the mainstay of therapy. The median mortality rate was estimated to be 21.4% (IQR 31.9%), increased by the presence of pulmonary (80% (IQR 50%) or cerebral involvement (50% (IQR 63.9%). In summary, different CAM clinical phenotypes need to be distinguished, influenced by geographical presentation. Opportunities exist for diagnosis and therapy optimization, based on earlier high-dose antifungal therapy, early source control, strict glycemic control and restriction of steroids to COVID-19 patients with oxygen requirements.
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页数:28
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