Reports are increasing on the emergence of COVID-19–associated mucormycosis (CAM) globally, driven particularly by low- and middle-income countries. The recent unprecedented surge of CAM in India has drawn worldwide attention. More than 28,252 mucormycosis cases are counted and India is the first country where mucormycosis has been declared a notifiable disease. However, misconception of management, diagnosing and treating this infection continue to occur. Thus, European Confederation of Medical Mycology (ECMM) and the International Society for Human and Animal Mycology (ISHAM) felt the need to address clinical management of CAM in low- and middle-income countries. This article provides a comprehensive document to help clinicians in managing this infection. Uncontrolled diabetes mellitus and inappropriate (high dose or not indicated) corticosteroid use are the major predisposing factors for this surge. High counts of Mucorales spores in both the indoor and outdoor environments, and the immunosuppressive impact of COVID-19 patients as well as immunotherapy are possible additional factors. Furthermore, a hyperglycaemic state leads to an increased expression of glucose regulated protein (GRP- 78) in endothelial cells that may help the entry of Mucorales into tissues. Rhino-orbital mucormycosis is the most common presentation followed by pulmonary mucormycosis. Recommendations are focused on the early suspicion of the disease and confirmation of diagnosis. Regarding management, glycaemic control, elimination of corticosteroid therapy, extensive surgical debridement and antifungal therapy are the standards for proper care. Due to limited availability of amphotericin B formulations during the present epidemic, alternative antifungal therapies are also discussed.

中文翻译：

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ECMM/ISHAM 针对低收入和中等收入国家 COVID-19 相关毛霉菌病临床管理的建议

全球范围内出现的与 COVID-19 相关的毛霉菌病 (CAM) 的报告越来越多，尤其是在低收入和中等收入国家的推动下。最近印度CAM空前的兴起引起了全世界的关注。据统计，毛霉菌病病例超过 28,252 例，印度是第一个将毛霉菌病宣布为法定传染病的国家。然而，对这种感染的管理、诊断和治疗的误解仍然存在。因此，欧洲医学真菌学联合会 (ECMM) 和国际人类和动物真菌学学会 (ISHAM) 认为有必要解决低收入和中等收入国家 CAM 的临床管理问题。本文提供了一份全面的文件来帮助临床医生管理这种感染。不受控制的糖尿病和不适当（高剂量或未指示）皮质类固醇的使用是这种激增的主要诱发因素。室内和室外环境中毛霉孢子的高计数、COVID-19 患者的免疫抑制影响以及免疫治疗可能是其他因素。此外，高血糖状态会导致内皮细胞中葡萄糖调节蛋白（GRP-78）的表达增加，这可能有助于毛霉目进入组织。鼻眼眶毛霉菌病是最常见的表现，其次是肺毛霉菌病。建议侧重于疾病的早期怀疑和诊断的确认。在治疗方面，血糖控制、取消皮质类固醇治疗、广泛的手术清创和抗真菌治疗是适当护理的标准。由于目前流行期间两性霉素 B 制剂的供应有限，因此还讨论了替代抗真菌疗法。