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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Eker C, Tarkan O, Surmelioglu O, Dagkiran M, Tanrisever I, Yucel Karakaya SP, et al. Alternating pattern of rhino-orbital–cerebral mucormycosis with COVID-19 in diabetic patients. Eur Arch Otorhinolaryngol. 2023;280(2):849–58. https://doi.org/10.1007/s00405-022-07526-0
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Issa RS, Mushtaq G, Unnisa A, Mahli A. A case of concomitant leukemoid reaction and mucormycosis in a patient with severe COVID-19 infection. Turk J Biochem. 2023;48(1):93–6. https://doi.org/10.1515/tjb-2023-0016
Ghasemi S, Dashti M, Fahimipour A, Daryakenari G, Mirzaei F, Akbari F, et al. Onset of mucormycosis in patients with COVID-19: a systematic review on patients’ characteristics. Eur J Dent. 2023;17(1):8–16. https://doi.org/10.1055/s-0042-1751003
Slavin M, van Hal S, Sorrell TC, Lee A, Marriott DJ, Daveson K, et al. Invasive infections due to filamentous fungi other than Aspergillus: epidemiology and determinants of mortality. Clin Microbiol Infect. 2015;21(6):490.e1–e10. https://doi.org/10.1016/j.cmi.2014.12.021
Lin E, Moua T, Limper AH. Pulmonary mucormycosis: clinical features and outcomes. Infection. 2017;45(4):443–8. https://doi.org/10.1007/s15010-017-0991-6
Prakash H, Ghosh AK, Rudramurthy SM, Singh P, Xess I, Savio J, et al. A prospective multicenter study on mucormycosis in India: epidemiology, diagnosis, and treatment. Med Mycol. 2019;57(4):395–402. https://doi.org/10.1093/mmy/myy060
Prakash H, Chakrabarti A. Global epidemiology of mucormycosis. Journal of Fungi 2019;5. https://doi.org/10.3390/jof5010026.
Ribes JA, Vanover-Sams CL, Baker DJ. Zygomycetes in human disease. Clin Microbiol Rev 2000;13. https://doi.org/10.1128/CMR.13.2.236-301.2000.
McMahon D, Frangos J. 15109 Cutaneous zygomycosis presenting as resistant intertrigo in an immunocompromised adult. J Am Acad Dermatol 2020;83. https://doi.org/10.1016/j.jaad.2020.06.202.
Jeong W, Keighley C, Wolfe R, Lee WL, Slavin MA, Kong DCM, et al. The epidemiology and clinical manifestations of mucormycosis: a systematic review and meta-analysis of case reports. Clinical Microbiology and Infection 2019;25. https://doi.org/10.1016/j.cmi.2018.07.011.
Petrikkos G, Skiada A, Lortholary O, Roilides E, Walsh TJ, Kontoyiannis DP. Epidemiology and clinical manifestations of mucormycosis. Clinical Infectious Diseases 2012;54. https://doi.org/10.1093/cid/cir866.
Sodhi SPS, Brar GK, Sodhi DPS, Brar GS, Gupta S, Malhotra M. Post COVID Fungal Osteomyelitis—Another Killer. J Pharm Bioallied Sci 2023;15. https://doi.org/10.4103/jpbs.jpbs_37_23.
Mukherjee B, Raichura ND, Alam MS. Fungal infections of the orbit. Indian J Ophthalmol 2016;64. https://doi.org/10.4103/0301-4738.185588.
Nicolás S, Enmanuel P, Betsabe S, Patricia L. Cavernous Sinus Thrombosis as a Complication of Cerebro-Rhino Orbital Mucormycosis Associated With Covid-19: A Case Report. International Journal of Oral and Dental Health 2022;8. https://doi.org/10.23937/2469-5734/1510147.
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