covid -19后侵袭性肺真菌病

S. Swain, K. Sharma, A. Ray, S. Vyas, Gagandeep Singh, M. Joshi, D. Jain, I. Xess, Sanjeev Sinha, N. Wig
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引用次数: 3

摘要

COVID-19与各种表现和不良后果有关。COVID-19不太常见的后果之一是急性COVID-19患者或恢复期患者发生继发感染。继发性侵袭性真菌感染(IFIs)在其他病毒感染如流感、副流感和呼吸道合胞病毒感染中也有早期观察到。SARS-CoV-2感染导致的严重肺损伤和免疫紊乱易发生重复感染。继发性IFI的危险因素包括由SARS-CoV-2感染、中性粒细胞减少或淋巴细胞减少、控制不良的糖尿病、结构性肺病真菌定植以及作为COVID-19治疗药物的皮质类固醇或免疫调节剂等药物引起的免疫紊乱和免疫瘫痪。COVID-19后的侵袭性曲霉病是最常见的真菌感染,但也有其他非曲霉真菌感染(包括毛霉病)的报道。本文描述了两个有趣的继发性感染病例,这些病例发生在COVID-19急性期以外的患者中,他们具有相似的症状,但诊断不同,需要不同的管理策略。病例1为新型冠状病毒相关亚急性侵袭性肺曲霉病(SAIA),病例2为新型冠状病毒相关肺毛霉菌病(CAPM)。我们还描述了COVID-19患者中超添加真菌感染的各种假定的免疫发病机制。
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Post-COVID-19-Invasive Pulmonary Mycosis
COVID-19 has been associated with myriad manifestations as well as adverse outcomes. One of the less commonly reported consequences of COVID-19 is the occurrence of secondary infections in patients suffering acutely from COVID-19 or in those recuperating. Secondary invasive fungal infections (IFIs) have also been observed earlier in other viral infections such as influenza, parainfluenza, and respiratory syncytial virus infections. Severe lung damage and immunologic derangement resulting from SARS-CoV-2 infection predispose to superinfections. Risk factors for secondary IFI includes immunologic derangement and immunoparalysis resulting from SARS-CoV-2 infection, neutropenia, or lymphopenia, poorly controlled diabetes, structural lung disease fungal colonization, and drugs such as corticosteroids or immunomodulators given as therapies for COVID-19. Invasive aspergillosis following COVID-19 is most commonly described fungal infection but other non-Aspergillus fungal infections (including mucormycosis) has also been reported. Herein we describe two interesting cases of secondary infections developing in patients beyond the acute phase of COVID-19 who had similar presentations but with different diagnoses and requiring different management strategies. Patient in case 1 developed COVID-19-associated subacute invasive pulmonary aspergillosis (SAIA) and patient in case 2 had COVID-19 associated pulmonary mucormycosis (CAPM). We have also described the various postulated immune-pathogenesis of the super-added fungal infections in COVID-19 patients.
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