目的:第二波COVID-19大流行与毛霉菌病病例的空前增加有关,由于与两性霉素相关的可用性和副作用,其治疗一直具有挑战性。
方法:将2021年4月至2021年6月COVID-19感染后出现鼻眶脑毛霉菌病(ROCM)的所有患者纳入这项回顾性干预研究。主要目的是评估静脉内脂质体两性霉素B(4-5mg/kg/天)和碘化钾饱和溶液(SSKI)口服联合手术清创的临床反应。
结果:25例ROCM患者接受该方案治疗。平均年龄和空腹血糖水平分别为53.48岁和239.64mg/dL。所有患者均有类固醇摄入史,平均每日剂量为86.39mg泼尼松龙当量。88%的患者诊断为毛霉菌病。在52%的以根霉为主要物种的患者中,培养物呈阳性。接受的两性霉素的平均日剂量为268mg/天,平均持续时间为9.52天。SSKI的平均日剂量为2.57g。21名患者(84%)在第8周病情稳定,在治疗结束时治愈,而死亡率为16%。显着影响结果的因素是眼睛和中枢神经系统(CNS)参与表现。
结论:SSKI,凭借其非常低的成本和安全性,使其成为一种潜在的辅助药物,可能有助于实现LAMB持续时间和剂量缩短的双重益处。
OBJECTIVE: Second wave of COVID-19 pandemic was associated with an unprecedented rise in cases of mucormycosis, treatment of which has been challenging owing to the availability and side effects associated with
amphotericin.
METHODS: All patients presenting with rhino-orbital cerebral mucormycosis (ROCM) following COVID-19 infection between April 2021 to June 2021 were included in this retrospective interventional
study. Primary objective was to assess the clinical response with combination of intravenous liposomal
amphotericin B (4-5 mg/kg/day) and saturated solution of potassium iodide (SSKI) given orally along with surgical debridement.
RESULTS: Twenty-five patients of ROCM were treated with the regimen. Mean age and fasting blood sugar levels were 53.48 years and 239.64 mg/dL respectively. All patients had history of intake of steroids with a mean daily dose of 86.39 mg of prednisolone equivalent. 88% of patients had a \"proven\" diagnosis of mucormycosis. Cultures were positive in 52% of patients with Rhizopus arrhizus as the predominant species. The mean daily dose of
amphotericin received was 268 mg/day with a mean duration of 9.52 days. Mean daily dose of SSKI was 2.57 g. 21 patients (84%) had stabilization of disease at week 8 and achieved cure at the end of treatment whereas the mortality rate was 16%. Factors that significantly affected outcome were eye and central nervous system (CNS) involvement on presentation.
CONCLUSIONS: SSKI, with its remarkably low cost and safety profile, makes it a potential adjuvant drug that may help achieve the twin benefits of shortened duration and dose of LAMB.