背景:犀牛-眶-脑毛霉菌病(ROCM)是一种罕见的,机会主义,血管侵入性,以及根霉属霉菌引起的致命感染,Mucor,和根佐科。ROCM的全球发病率为百万分之0.005-1.7,死亡率为46%。早期诊断和治疗对这种疾病至关重要,延迟一周可以将死亡率提高到66%。
方法:一名32岁男性,Janakpur过去15天已知的2019年冠状病毒病(COVID-19)病例,Dhanusha,尼泊尔向Dhulikhel医院急诊科就诊,左眼突然出现视力模糊,左侧眼痛,还有最近三天的鼻出血.
方法:患者被怀疑患有COVID-19后毛霉菌病,和氢氧化钾(KOH)安装的鼻拭子在显微镜下显示菌丝。静脉和球后脂质体两性霉素B作为药物治疗给药,以及手术清创。治疗需要多学科方法。
结论:长期,多模式治疗方法包括联合抗真菌药物治疗(静脉注射脂质体两性霉素B和球后两性霉素B),及时的手术清创可改善短期和长期结局.
BACKGROUND: Rhino-orbital-cerebral
mucormycosis (ROCM) is a rare, opportunistic, angio-invasive, and fatal infection caused by mold fungi of the genera Rhizopus, Mucor, and Rhizomucor. The global incidence of ROCM is 0.005-1.7 per million, with a fatality rate of 46%. Early diagnosis and treatment are crucial for this disease, as a delay of one week can increase the mortality rate to 66%.
METHODS: A 32-year-old male, a known case of coronavirus disease 2019 (COVID-19) for the past 15 days from Janakpur, Dhanusha, Nepal presented to the emergency department of Dhulikhel Hospital with a sudden onset of blurred vision in the left eye, left-sided ocular pain, and nasal bleeding for the last three days.
METHODS: The patient was suspected of post-COVID-19
mucormycosis, and a nasal swab for potassium hydroxide (KOH) mount showed hyphae in microscopy. Intravenous and retrobulbar liposomal amphotericin B were administered as medical therapy, along with surgical debridement. A multidisciplinary approach was necessary for the treatment.
CONCLUSIONS: A long-term, multimodal treatment approach involving combined antifungal drug therapy (intravenous liposomal amphotericin B and retrobulbar amphotericin B), and timely surgical debridement leads to an improvement in both short-term and long-term outcomes.