Pathogenesis of Mucormycosis
Pathogenesis of Mucormycosis
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DOI：
10.1093/cid/cir865
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发表时间：
2012-02-01
影响因子：
11.8
通讯作者：
Kontoyiannis, Dimitrios P.
中科院分区：
文献类型：
--
作者：
Ibrahim, Ashraf S.;Spellberg, Brad;Kontoyiannis, Dimitrios P.
毛霉菌病是一种危及生命的感染，发生在由于糖尿病酮症酸中毒、中性粒细胞减少、器官移植和/或血清有效铁水平升高而导致免疫功能低下的患者。由于糖尿病、癌症和器官移植的患病率不断上升，面临这种致命感染风险的患者数量正在增加。尽管进行了积极的治疗，包括毁容手术清创和经常附加的毒性抗真菌治疗，但总体死亡率很高。迫切需要预防和治疗毛霉病的新策略。了解毛霉病的发病机制和宿主对入侵菌丝的最终反应将为新的治疗干预措施提供靶点。在这一补充中，我们回顾了目前关于毛霉病最常见的病原体米根霉所使用的毒力特征的知识。由于血清有效铁水平升高的患者特别容易患毛霉菌病，而且这些感染具有高度的血管侵袭性，因此重点放在机体从宿主获取铁的能力以及它与血管内皮细胞的相互作用上。在临床前阶段确定了几种有希望的治疗策略。
Mucormycosis is a life-threatening infection that occurs in patients who are immunocompromised because of diabetic ketoacidosis, neutropenia, organ transplantation, and/or increased serum levels of available iron. Because of the increasing prevalence of diabetes mellitus, cancer, and organ transplantation, the number of patients at risk for this deadly infection is increasing. Despite aggressive therapy, which includes disfiguring surgical debridement and frequently adjunctive toxic antifungal therapy, the overall mortality rate is high. New strategies to prevent and treat mucormycosis are urgently needed. Understanding the pathogenesis of mucormycosis and the host response to invading hyphae ultimately will provide targets for novel therapeutic interventions. In this supplement, we review the current knowledge about the virulence traits used by the most common etiologic agent of mucormycosis, Rhizopus oryzae. Because patients with elevated serum levels of available iron are uniquely susceptible to mucormycosis and these infections are highly angioinvasive, emphasis is placed on the ability of the organism to acquire iron from the host and on its interactions with endothelial cells lining blood vessels. Several promising therapeutic strategies in preclinical stages are identified.