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Abstract：
COVID-associated rhino-orbito-cerebral Mucormycosis (CA-ROCM), henceforth referred to as Covid-Associated Mucormycosis (CAM), is a serious and fatal condition unless treated promptly and completely. The main treatment of the CAM is complete surgical debridement and administration of systemic antifungals. The first line antifungal recommended for CAM is Amphotericin-B. Since Amphotericin-B has systemic side effects mainly on the renal system, a timely decision to start and end Amphotericin-B therapy is very essential. Besides the Computed Tomography (CT) scan, serum levels of C-reactive protein (CRP) levels are a good indicator of CAM-associated inflammation levels in the patient\'s body. By monitoring the CRP levels, we can titrate amphotericin treatment to cause minimal harm to the kidneys. Our study was done to analyze the kinetics of C-reactive protein in patients of CAM admitted in a tertiary-care hospital and compare it with the CRP levels in COVID-associated non-Mucormycosis Sinusitis patients. Aim and objective To study the kinetics of serum C-reactive protein (CRP) levels among patients undergoing in-patient care for COVID-associated rhino-orbito-cerebral mucormycosis and compare with serum CRP levels in COVID-19 patients suffering from sinusitis without rhino-orbito-cerebral mucormycosis. Materials and methods This was a retrospective cohort study. The source of data was post-COVID sinusitis patients who were admitted during 2nd wave of COVID-19 in India in our hospital whose medical records were accessed by the Medical Records Department. The subjects were recruited into the two study groups namely the Mucormycosis group and the non-Mucormycosis group based on the histopathological report of the nasal biopsy specimen. The medical records of each member of the two groups were studied for the levels of serum C-reactive protein measured at the time of admission and every 5(+1) days thereafter till the time of discharge. The kinetics of serum C-reactive protein levels, which is a marker of inflammation is studied in each of the two groups and compared using statistical methods. Results There was a significant difference between Mucormycosis and Non-Mucormycosis groups in CRP-level kinetics. However, there was no significant trend of decrease or increase over time in Mucormycosis as well as non-Mucormycosis cases. Conclusion CRP is an important biomarker in assessing the septic response to COVID-associated rhino-orbito-cerebral mucormycosis. Detection of raised CRP levels helps in prompt early initiation of anti-fungal treatment. Also, monitoring the levels of serum CRP will guide in deciding the time to stop the antifungals at an appropriate time. CRP monitoring is commonly available and affordable. Hence, we recommend CRP monitoring of in-patients of CAM.
摘要：
COVID相关犀牛或脑毛霉菌病（CA-ROCM），此后称为Covid相关毛霉菌病(CAM)，除非得到及时和彻底的治疗，否则是一种严重和致命的疾病。CAM的主要治疗是完全手术清创和全身抗真菌药的给药。推荐用于CAM的一线抗真菌药物是两性霉素B。由于两性霉素B主要对肾脏系统有全身副作用，及时决定开始和结束两性霉素B治疗非常重要.除了计算机断层扫描(CT)扫描,血清C反应蛋白（CRP）水平是患者体内CAM相关炎症水平的良好指标。通过监测CRP水平，我们可以滴定两性霉素治疗对肾脏的伤害最小。我们的研究旨在分析三级医院收治的CAM患者中C反应蛋白的动力学，并将其与COVID相关的非毛霉菌病性鼻窦炎患者的CRP水平进行比较。目的与目的研究COVID相关鼻-流脑毛霉菌病住院患者血清C反应蛋白（CRP）水平的动力学，并与无鼻-流脑毛霉菌病的COVID-19鼻窦炎患者的血清CRP水平进行比较。材料和方法这是一项回顾性队列研究。数据来源是COVID后鼻窦炎患者，这些患者是在印度第二波COVID-19期间在我们医院入院的，其病历由医疗记录部门访问。根据鼻活检标本的组织病理学报告，将受试者招募到两个研究组，即毛霉菌病组和非毛霉菌病组。研究两组每个成员的病历，以了解入院时及出院后每5（1）天测量的血清C反应蛋白水平。血清C反应蛋白水平的动力学，这是炎症的标志物，在两组中进行研究，并使用统计学方法进行比较。结果毛霉菌病与非毛霉菌病组CRP水平动力学差异有统计学意义。然而,在毛霉菌病和非毛霉菌病病例中,随着时间的推移没有显著的减少或增加的趋势.结论CRP是评估COVID相关犀牛或脑毛霉菌病脓毒症反应的重要生物标志物。检测升高的CRP水平有助于促进抗真菌治疗的早期开始。此外，监测血清CRP水平将指导决定在适当时间停止抗真菌药物的时间。CRP监测通常可用且负担得起。因此，我们建议对CAM住院患者进行CRP监测.
