Die Mukormykose in Zeiten von COVID-19: Risiken und Herausforderungen

Durch einen sprunghaften Anstieg der Infektionszahlen im Rahmen der COVID-19 Pandemie hat die Mukormykose, eine sonst eher seltene Pilzinfektion, weltweit Bekanntheit erlangt. In diesem Artikel untersuchen wir die Risikofaktoren und Mechanismen, die zu dieser viral-fungalen Koinfektion führen. Wir betrachten die globalen Verteilungsmuster, die klinische Präsentation und die Herausforderungen bei der Diagnose und Behandlung der COVID-19-assoziierten Mukormykose.

Abstract

The first patients positive for SARS-CoV-2 were registered in December 2019. In March 2020, the World Health Organization (WHO) declared the COVID-19 outbreak a global pandemic, the beginning of a worldwide health crisis that revealed numerous medical challenges for healthcare systems and pandemic emergency strategies.

Among these challenges, mucormycosis, a typically rare fungal infection, gained global attention. With an average global incidence of about 2 per 1 million people, mucormycosis is considered a very rare disease, an opportunistic infection mostly affecting the lungs or skin and soft tissues in immunocompromised patients. Poorly controlled diabetes mellitus is one of the leading risk factors for rhino-orbital mucormycosis. Countries with a high prevalence of diabetes and limited healthcare resources have higher mucormycosis rates, with India and Pakistan being among the nations with particularly high incidences.

During the second wave of the COVID-19 pandemic in India, mucormycosis rates surged dramatically within a few weeks, with over 47,500 cases of COVID-19-associated mucormycosis (CAM) reported between May and August 2021. Mucormycosis is characterized by a high mortality rate of up to 90%, especially when the diagnosis is delayed, and treatment commences late. There were concerns about a potentially global threat.

In this article, we explore the risk factors and mechanisms leading to this viral-fungal coinfection. We present global distribution patterns, clinical presentation, and challenges in the diagnosis and treatment of COVID-19-associated mucormycosis.

Kernaussagen

• Schlecht eingestellter Diabetes mellitus und Immunsuppression sind Hauptrisikofaktoren für das Auftreten von Mukormykosen.

• Ein ungewöhnlicher Anstieg an Mukormykose-Fällen während der zweiten COVID-19-Welle in Indien wurde unter anderem mit unsachgemäßer Verabreichung von Glukokortikosteroiden in Verbindung gebracht.

• Diabetes und die Gabe von Glukokortikosteroiden auch bei milden Verläufen von COVID-19 waren mit ca. 80% die häufigsten Risikofaktoren für Mukormykosen in Indien im Jahr 2021.

• Nach der nationalen Implementierung von Richtlinien zur Behandlung von COVID-19 und zur Prävention von Pilzinfektionen zeigte sich ein Rückgang der Mukormykose-Fallzahlen zum Ende des Jahres 2021 hin.

• Die Blutzuckerkontrolle ist von Bedeutung, um das Risiko für Mukormykosen zu minimieren.

• Die frühzeitige Diagnose der Mukormykose, die umgehende Gabe von Antimykotika und das chirurgische Débridement sind entscheidend für den Erfolg der Therapie.

Publication History

Article published online:
24 April 2024

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