Oh Daniel, Notrica David
University of Arizona College of Medicine, Phoenix Integrated Surgical Residency, Phoenix, AZ, USA.
J Pediatr Surg. 2002 Nov;37(11):1607-11. doi: 10.1053/jpsu.2002.36193.
A case of angioinvasive cutaneous mucormycosis in a premature infant, eventually requiring extracorporeal membrane oxygenation therapy, is described. The fungal infection began at the site of a brachial artery catheter that had been covered with an adhesive dressing in the left antecubital fossa. The infection progressed rapidly over a 5-day period, and a left arm amputation was required. Fungal hyphae were present at the margins of resection. The patient eventually had disseminated mucormycosis and died. A second case of cutaneous mucormycosis in another premature infant also is presented. This infant had the infection at an intravenous catheter site. Rapid initiation of surgical debridement of the wound and amphotericin B therapy resulted in patient survival. Eighteen reported cases of cutaneous mucormycosis in neonates were found and are reviewed. Prematurity, low birth weight, broad-spectrum antibiotics, corticosteroid therapy, and local trauma to the skin site were common risk factors. Only 7 of the 18 patients survived. Therapy consisted of local debridement and intravenous amphotericin B. High index of suspicion, early diagnosis, and rapid institution of therapy can improve survival rate. The key to prevention appears to be appropriate skin care.
本文描述了一例早产儿血管侵袭性皮肤毛霉病，最终需要体外膜肺氧合治疗。真菌感染始于左肘前窝处用粘性敷料覆盖的肱动脉导管部位。感染在5天内迅速进展，需要进行左臂截肢。切除边缘可见真菌菌丝。该患者最终发生播散性毛霉病并死亡。本文还介绍了另一例早产儿皮肤毛霉病。该婴儿在静脉导管部位发生感染。伤口的手术清创和两性霉素B治疗的迅速启动使患者存活。发现并回顾了18例新生儿皮肤毛霉病的报道病例。早产、低出生体重、广谱抗生素、皮质类固醇治疗和皮肤部位的局部创伤是常见的危险因素。18例患者中仅7例存活。治疗包括局部清创和静脉注射两性霉素B。高度怀疑、早期诊断和迅速开始治疗可提高生存率。预防的关键似乎是适当的皮肤护理。
