A prospective study of mucormycosis in north India: Experience from a tertiary care hospital
A prospective study of mucormycosis in north India: Experience from a tertiary care hospital
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DOI：
10.1093/mmy/myu086
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发表时间：
2015-04-01
期刊：
影响因子：
2.9
通讯作者：
Attri, Ashok Kumar
中科院分区：
文献类型：
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作者：
Bala, Kiran;Chander, Jagdish;Attri, Ashok Kumar
毛霉菌病是由普遍存在的毛霉菌目和毛霉菌纲丝状真菌引起的一种新出现的血管侵袭性感染。我们对2010年1月至2011年6月在三级医院诊断为毛霉病的38例患者进行了前瞻性研究。我们分析了这些病例的受累部位、潜在疾病和分离真菌的种类、分离真菌的抗真菌敏感性模式和治疗结果。患者平均年龄40.43岁，男性占72%。鼻眶毛霉菌病（61.5%）是最常见的症状，其次是皮肤症状（31%）、胃肠道症状（5%）和肺部症状（2.5%）。糖尿病（56%）是鼻-眶-脑表现的重要危险因素（OR = 7.55, P = 0.001）。在23株培养菌株中，以arrhizopus arrhizus（37.5%）最为常见，其次为Apophysomyces variabilis（29.2%）、Lichtheimia ramosa（16.7%）、microsporus（4.2%）、Rhizomucor pusillus（4.2%）和Apophysomyces elegans（4.2%）。阿根霉主要从鼻-眶-脑毛霉病中分离得到，而棘霉主要从皮肤毛霉病中分离得到。体外抗真菌药敏结果显示，16株菌株对两性霉素B （MIC < 1 μ g/ml）敏感，而对伏立康唑（MIC-0.25 ~ bbb8）、氟康唑（MIC- bbb32）、氟胞嘧啶（MIC- bbb32）均耐药。治疗方案包括抗真菌治疗、逆转潜在的易感危险因素和手术清创。手术和内科联合使用两性霉素B的患者生存率（OR = 0.2, P < 0.04）明显优于单用两性霉素B （61.5% vs 10.3%）。临床医生对真菌疾病的认识是减少疾病致命后果的必要条件。
Mucormycosis is an emerging angioinvasive infection caused by the ubiquitous filamentous fungi of the Order Mucorales and class of Mucormycetes. We conducted a prospective study of 38 patients who were diagnosed as having mucormycosis in a tertiary care hospital during January 2010 to June 2011. The cases were analyzed regarding the site of involvement, underlying disease and species of fungi isolated, antifungal susceptibility pattern of the isolates, and outcome of therapy. The mean age of the patients was 40.43 years, with 72% male. Rhino-orbital mucormycosis (61.5%) was the most common presentation followed by cutaneous manifestations (31%), gastrointestinal symptoms (5%), and pulmonary (2.5%). Diabetes mellitus (56%) was the significant risk factor in rhino-orbito-cerebral presentation (OR = 7.55, P = 0.001). Among 23 culture isolates, Rhizopus arrhizus (37.5%) was the most common, followed by Apophysomyces variabilis (29.2%), Lichtheimia ramosa (16.7%), Rhizopus microsporus (4.2%), Rhizomucor pusillus (4.2%), and Apophysomyces elegans (4.2%). Rhizopus arrhizus was most commonly isolated from rhino-orbito-cerebral mucormycosis and Apophysomyces species were generally obtained from cutaneous mucormycosis. In vitro antifungal susceptibility showed that 16 isolates were sensitive to amphotericin B (MIC less than 1 mu g/ml), while in contrast, all isolates were found to be resistant to voriconazole (MIC-0.25 to > 8), fluconazole (MIC > 32), flucytosine (MIC > 32). Treatment regimens included antifungal therapy, reversal of underlying predisposing risk factors, and surgical debridement. Combination of surgery and medical treatment with amphotericin B was significantly better (OR = 0.2, P < 0.04) than amphotericin B alone (61.5% vs. 10.3% patient survival). The awareness of fungal diseases amongst clinicians is required to decrease the fatal outcome of disease.