背景：自从新型冠状病毒病（COVID-19）爆发以来，COVID-19共感染病例在世界范围内的报道越来越多。毛霉菌病,由Mucorales命令成员引起的机会性真菌感染，在重症和危重症COVID-19患者中经常被隔离。
方法：最初，令人印象深刻的，临床,彻底报道了来自埃及的7例COVID-19相关毛霉菌病（CAM）病例的副临床特征。随后，对文献进行了广泛的回顾，以描述全球CAM病例的特征，目的探讨CAM患者死亡的潜在危险因素。
结果：在病例系列报告的7名患者中，五名(71.4%)为男性，6人（85.7%）患有糖尿病，3人(42.9%)有心血管疾病。所有患者在计算机断层扫描扫描下表现出各种形式的面部畸形，其中两人使用聚合酶链反应（PCR）测试对Mucorales呈阳性。脂质体两性霉素B（LAmB）适用于所有病例，直到随访结束他们都没有死.在回顾文献时，全世界报告了191例，其中74.4%是男性，83.2%来自中低收入国家，55岁或以下的占51.4%。糖尿病（79.1%），慢性高血压（30％），和肾脏疾病/衰竭（13.6%）是最常见的医疗合并症，而类固醇（64.5％）是COVID-19最常用的处方药，其次是Remdesivir（18.2％），抗生素(12.7%)，和Tocilizumab（5.5％）。
结论：由于大多数纳入的研究都是观察性研究，获得的证据需要仔细解释。糖尿病,类固醇,和Remdesivir与死亡风险增加无关，因此确认用于治疗重症和危重症COVID-19患者的类固醇不应停用.肺受累,双边表现，根霉分离与死亡风险增加有关，从而确认主动筛查势在必行，特别是对于危重病人。最后,手术管理和抗真菌药物，例如，两性霉素B和泊沙康唑，与死亡风险降低有关，从而确认其有效性。
BACKGROUND: Since the novel coronavirus disease (COVID-19) outbreak, the cases of COVID-19 co-infections have been increasingly reported worldwide. Mucormycosis, an opportunistic fungal infection caused by members of the Mucorales order, had been frequently isolated in severely and critically ill COVID-19 patients.
METHODS: Initially, the anamnestic, clinical, and paraclinical features of seven COVID-19-associated mucormycosis (CAM) cases from Egypt were thoroughly reported. Subsequently, an extensive review of the literature was carried out to describe the characteristics of CAM cases globally, aiming to explore the potential risk factors of mortality in CAM patients.
RESULTS: Out of the seven reported patients in the
case series, five (71.4%) were males, six (85.7%) had diabetes mellitus, and three (42.9%) had cardiovascular disease. All patients exhibited various forms of facial deformities under the computed tomography scanning, and two of them tested positive for Mucorales using the polymerase chain reaction (PCR) testing. Liposomal amphotericin B (LAmB) was prescribed to all cases, and none of them died until the end of the follow-up. On reviewing the literature, 191 cases were reported worldwide, of which 74.4% were males, 83.2% were from low-middle income countries, and 51.4% were aged 55 years old or below. Diabetes mellitus (79.1%), chronic hypertension (30%), and renal disease/failure (13.6%) were the most common medical comorbidities, while steroids (64.5%) were the most frequently prescribed medication for COVID-19, followed by Remdesivir (18.2%), antibiotics (12.7%), and Tocilizumab (5.5%).
CONCLUSIONS: As the majority of the included studies were observational studies, the obtained evidence needs to be interpreted carefully. Diabetes, steroids, and Remdesivir were not associated with increased mortality risk, thus confirming that steroids used to manage severe and critical COVID-19 patients should not be discontinued. Lung involvement, bilateral manifestation, and Rhizopus isolation were associated with increased mortality risk, thus confirming that proactive screening is imperative, especially for critically ill patients. Finally, surgical management and antimycotic medications, e.g., amphotericin B and posaconazole, were associated with decreased mortality risk, thus confirming their effectiveness.
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