Epidemiological aspects and clinical outcome of patients with Rhinocerebral zygomycosis: a survey in a referral hospital in Iran.
Epidemiological aspects and clinical outcome of patients with Rhinocerebral zygomycosis: a survey in a referral hospital in Iran.
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DOI：
10.11604/pamj.2016.24.232.9688
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发表时间：
2016
期刊：
影响因子：
--
通讯作者：
Ansari-Ramandi MM
中科院分区：
文献类型：
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作者：
Bozorgi V;Talebitaher M;Shalbaf N;Radmanesh N;Nasri F;Ansari-Ramandi MM
尚未发表有关鼻脑接合菌病感染的流行病学状况及其在我们人群中的结局的全面报告，因此，当前的研究旨在解决转诊至转诊医院的鼻脑接合菌病感染患者的流行病学特征和临床结局伊朗。这项回顾性研究在Rasoul-e-Akram医院进行，该医院是伊朗德黑兰的一家拥有800张床位的三级护理教学医院。对病理学记录的图表进行了审查，以确定2007年4月至2014年3月期间入院患者的所有鼻脑真菌病病例。鼻脑真菌病的诊断是基于组织病理学评估。对64例鼻脑真菌病患者进行了评估。患者的平均年龄为46.07 ± 22.59岁，51.6%为女性。其中糖尿病患者占67.2%，高血压患者占26.6%，癌症患者占29.7%。73.4%的患者合并不同鼻窦感染。在所有患者中，26.6%接受了外科手术，17.2%接受了药物控制。40.6%行广泛清创术。中性粒细胞（<1500个细胞/微升）在12.5%中显示。住院死亡率为35.9%，住院时间延长（> 14天）占60.9%。根据多变量logistic回归分析，院内死亡率的主要预测因素包括女性性别、高龄、鼻窦感染和中性粒细胞减少，而给予更高剂量的阿替沙星对预防早期死亡具有保护作用。在一个类似的多变量模型中，癌症史可以预测住院时间延长，而使用更高剂量的阿替西霉素可以缩短住院时间。我们的鼻脑真菌病患者的人口统计学特征与其他国家的患者没有差异。糖尿病的存在与这种感染的存在密切相关。鼻窦受累在鼻脑真菌病患者中非常常见，导致高死亡率和发病率。除女性外，高龄和中性粒细胞减少是早期死亡率增加的主要危险因素。使用更高剂量的抗真菌治疗，如阿替霉素，可以防止死亡和延长住院时间。癌症患者可能需要更长的住院时间，因为需要全面的住院治疗。
No comprehensive reports have been published on epidemiological status of Rhinocerebral zygomycosis infections and its outcome in our population, Hence, the current study came to address epidemiological characteristics as well as clinical outcome of patients with Rhinocerebral zygomycosis infection referred to a referral hospital in Iran. This retrospective study was performed at the Rasoul-e-Akram hospital, an 800-bed tertiary care teaching hospital in Tehran, Iran. The pathology recorded charts were reviewed to identify all cases of Rhinocerebral zygomycosis from patients admitted between April 2007 and March 2014. A diagnosis of Rhinocerebral zygomycosis was based on histopathological assessments. Sixty four patients with Rhinocerebral zygomycosis were assessed. The mean age of the patients was 46.07 ± 22.59 years and 51.6% were female. Among those, 67.2% were diabetic, 26.6% were hypertensive and 29.7% had history of cancer. Different sinuses were infected in 73.4% of the patients. Out of all the patients 26.6% underwent surgical procedures and 17.2% were controlled medically. Extensive debridement was carried out in 40.6%. Neutropenia (<1500 cell/ µl) was revealed in 12.5%. In-hospital mortality rate was 35.9% and prolonged hospital stay (> 14 days) was found in 60.9%. According to the Multivariable logistic regression analysis, the main predictors of in-hospital mortality included female gender, advanced age, the presence of sinus infection, and neutropenia, while higher dosages of amphotericin administered had a protective role in preventing early mortality. In a similar Multivariate model, history of cancer could predict prolonged hospital stay, whereas using higher dose of amphotericin could lead to shortening length of hospital stay. There is no difference in demographic characteristics between our patients with Rhinocerebral zygomycosis and other nations. The presence of diabetes mellitus is closely associated with the presence of this infection. Sinus involvement is very common in those with Rhinocerebral zygomycosis leading to high mortality and morbidity. Besides female gender, advanced age, and presence of neutropenia was a major risk factor for increasing early mortality. The use of higher doses of antifungal treatment such as amphotericin can prevent both mortality and prolonged hospital stay. The cancer patients may need longer hospital stay because of needing comprehensive in-hospital treatment.