Mucormicosis rino-órbito-cerebral asociada con COVID-19 y factores relacionados a la mortalidad. Revisión sistemática

Resumen

Introducción y objetivo: La mucormicosis rino-órbito-cerebral (MROC) emergió como una complicación grave durante la pandemia de COVID-19, especialmente en pacientes con diabetes mal controlada o tratados con corticosteroides. Esta infección rápida progresión, presenta altas tasas de mortalidad y plantea desafíos significativos en su diagnóstico y manejo. El objetivo de esta revisión sistemática fue analizar los factores clínicos asociados a la mortalidad en pacientes con MROC en el contexto de COVID-19. Método: Se llevó a cabo una revisión sistemática según las directrices PRISMA, utilizando bases de datos como Scopus, PUBMED y ScienceDirect, e incluyendo estudios originales en inglés publicados entre diciembre de 2019 y diciembre de 2024. La calidad de los estudios se evaluó con la Escala Newcastle-Ottawa. Se realizó un análisis descriptivo de medidas como razones de momios (OR), riesgos relativos (RR) e intervalos de confianza al 95 % (IC 95 %), considerando significativas aquellas asociaciones cuyo IC no incluía el valor nulo. No se efectuó metaanálisis debido a la heterogeneidad metodológica de los estudios. Resultados: Se identificaron 16 estudios que mostraron una mortalidad entre el 4.8 % y el 66.7 %. Los principales factores de riesgo asociados con la mortalidad incluyeron diabetes mellitus (67.64 %-95.33 %), uso de corticosteroides (72.3 %-74 %), edad avanzada y extensión intracraneal u orbitaria de la infección. El diagnóstico temprano y el tratamiento combinado (quirúrgico y médico) mejoraron significativamente las tasas de supervivencia. Discusión: La MROC asociada a COVID-19 está fuertemente vinculada a la diabetes y al uso de corticosteroides, que debilitan el sistema inmunológico y favorecen la infección fúngica. La extensión de la infección al sistema nervioso central o a las órbitas incrementó significativamente la mortalidad. Los estudios destacaron la importancia de un enfoque multidisciplinario y el manejo agresivo para mejorar los resultados. Conclusiones: La MROC relacionada con COVID-19 es una complicación grave con alta mortalidad, asociada principalmente a diabetes, uso de corticosteroides y extensión de la infección. Se requiere un diagnóstico temprano y un tratamiento combinado para mejorar la supervivencia. Futuras investigaciones deben enfocarse en estudios prospectivos y multicéntricos para optimizar las estrategias de prevención y manejo.
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