Abstract：
BACKGROUND: During the COVID-19 pandemic-associated mucor epidemic, acute antifungal drug shortage necessitated the exploration of other antifungals based on culture sensitivity. Itraconazole is a cheap, safe, and effective antifungal in sensitive cases.
METHODS: We enrolled itraconazole-sensitive COVID-19-associated mucormycosis during the mucormycosis pandemic. After the intensive phase course of liposomal amphotericin B, Itraconazole was offered in susceptible cases during the maintenance phase along with standard of care. These patients were clinically and radiologically followed for 6 months.
RESULTS: We enrolled 14 patients (Male: Female-11:3) of Rhino-orbito-cerebral mucormycosis (ROCM) which included 12 diabetics. All patients had facial swelling, orbital swelling, visual impairment, and headache. MRI showed involvement of bilateral sinus (10/14), orbital extension (13/14), cavernous sinus (5/14), cerebral part of the internal carotid artery (3/14), and brain infarcts (4/14). All 14 patients showed sensitivity to Itraconazole with 12 having minimum inhibitory concentration (MIC) ≤ 1 μg/ml and 2 having MIC ≤ 2 μg/ml. Follow-up at 6 months showed clinical improvement in the majority (11/14) and radiological improvement in six out of seven scanned patients.
CONCLUSIONS: Our study shows the potential therapeutic role of oral Itraconazole in ROCM.
METHODS: We enrolled itraconazole-sensitive COVID-19-associated mucormycosis during the mucormycosis pandemic. After the intensive phase course of liposomal amphotericin B, Itraconazole was offered in susceptible cases during the maintenance phase along with standard of care. These patients were clinically and radiologically followed for 6 months.
RESULTS: We enrolled 14 patients (Male: Female-11:3) of Rhino-orbito-cerebral mucormycosis (ROCM) which included 12 diabetics. All patients had facial swelling, orbital swelling, visual impairment, and headache. MRI showed involvement of bilateral sinus (10/14), orbital extension (13/14), cavernous sinus (5/14), cerebral part of the internal carotid artery (3/14), and brain infarcts (4/14). All 14 patients showed sensitivity to Itraconazole with 12 having minimum inhibitory concentration (MIC) ≤ 1 μg/ml and 2 having MIC ≤ 2 μg/ml. Follow-up at 6 months showed clinical improvement in the majority (11/14) and radiological improvement in six out of seven scanned patients.
CONCLUSIONS: Our study shows the potential therapeutic role of oral Itraconazole in ROCM.
摘要：
背景：在COVID-19大流行相关粘液流行期间，急性抗真菌药物短缺需要基于培养敏感性探索其他抗真菌药物。伊曲康唑是一种廉价的，安全,在敏感病例中有效的抗真菌药。
方法：我们在毛霉菌病大流行期间登记了伊曲康唑敏感的COVID-19相关毛霉菌病。在脂质体两性霉素B的密集阶段过程之后，伊曲康唑在维持阶段以及标准护理期间在易感病例中提供。这些患者在临床和放射学上随访6个月。
结果：我们招募了14例犀牛-口脑毛霉菌病（ROCM）患者（男性：女性-11:3），其中包括12名糖尿病患者。所有病人都有面部肿胀,眼眶肿胀,视力障碍，和头痛。MRI显示双侧窦受累（10/14），轨道延伸(13/14)，海绵窦（5/14），颈内动脉的大脑部分（3/14），和脑梗塞（4/14）。所有14例患者均对伊曲康唑敏感，其中12例最低抑制浓度（MIC）≤1μg/ml，2例MIC≤2μg/ml。6个月的随访显示，大多数（11/14）患者的临床改善和7名扫描患者中的6名的放射学改善。
结论：我们的研究显示了口服伊曲康唑在ROCM中的潜在治疗作用。
方法：我们在毛霉菌病大流行期间登记了伊曲康唑敏感的COVID-19相关毛霉菌病。在脂质体两性霉素B的密集阶段过程之后，伊曲康唑在维持阶段以及标准护理期间在易感病例中提供。这些患者在临床和放射学上随访6个月。
结果：我们招募了14例犀牛-口脑毛霉菌病（ROCM）患者（男性：女性-11:3），其中包括12名糖尿病患者。所有病人都有面部肿胀,眼眶肿胀,视力障碍，和头痛。MRI显示双侧窦受累（10/14），轨道延伸(13/14)，海绵窦（5/14），颈内动脉的大脑部分（3/14），和脑梗塞（4/14）。所有14例患者均对伊曲康唑敏感，其中12例最低抑制浓度（MIC）≤1μg/ml，2例MIC≤2μg/ml。6个月的随访显示，大多数（11/14）患者的临床改善和7名扫描患者中的6名的放射学改善。
结论：我们的研究显示了口服伊曲康唑在ROCM中的潜在治疗作用。
