Alexander Priya, Alladi Anand, Correa Marjorie, D'Cruz Ashley J
Department of Pathology, St. John's Medical College and Hospital, Bangalore, India.
J Trop Pediatr. 2005 Feb;51(1):54-9. doi: 10.1093/tropej/fmh077. Epub 2004 Dec 15.
Neonatal gastrointestinal (GI) mucormycosis is a rare, usually fatal, opportunistic fungal infection, which is difficult to diagnose early or preoperatively. We report three babies, only one of whom survived, with a review of the literature. All three had similar findings of necrosis of colon with multiple perforations. While the first baby was diagnosed as long segment Hirschsprung's, the second was treated as small left colon but went on to show signs of peritonitis. The third presented with pneumonia, which progressed to sepsis and peritonitis. All three were diagnosed by histology postoperatively and two of them succumbed, one in spite of amphotericin and the other as he was too sick to start antifungals and had a rapid downhill course. The one who survived did so even though she did not receive amphotericin, but had clear margins of resection. The only chance of survival in this fatal disease is early diagnosis and rapid institution of aggressive therapy inclusive of adequate surgical debridement and appropriate antifungal medications.
新生儿胃肠道毛霉菌病是一种罕见的、通常致命的机会性真菌感染，很难在早期或术前进行诊断。我们报告三例患儿，其中仅一人存活，并对相关文献进行综述。三例患儿均有类似表现，即结肠坏死伴多发穿孔。第一例患儿最初诊断为长段型先天性巨结肠，第二例最初按小左结肠综合征治疗，但随后出现腹膜炎体征。第三例患儿最初表现为肺炎，进而发展为败血症和腹膜炎。三例患儿均在术后经组织学确诊，其中两例死亡，一例尽管使用了两性霉素仍死亡，另一例因病情过重无法开始抗真菌治疗且病情迅速恶化而死亡。存活的患儿虽未接受两性霉素治疗，但手术切缘清晰。对于这种致命疾病，存活的唯一机会是早期诊断并迅速采取积极治疗措施，包括充分的手术清创和适当的抗真菌药物治疗。
