Csomor Judit, Nikolova Radka, Sinkó János, Reményi Péter, Szabó Zsuzsanna
Fovárosi Szt. László Kórház, Patológiai Osztály, Budapest.
Orv Hetil. 2004 Dec 12;145(50):2507-13.
Over recent years the clinical importance of invasive fungal infections has significantly increased. Mucormycosis refers to a rare, life threatening, opportunistic disease caused by filamentous fungi of the order Mucorales. Most frequently mucormycosis occurs in patients with ketoacidotic diabetes and in neutropenic patients with acute leukaemia. This study of fifteen patients was conducted to evaluate the clinical characteristics of invasive mucormycosis, and goal was also to propose for an early diagnosis and management as survival can only be improved by aggressive surgery and antifungal therapy. In a retrospective analysis of the biopsy and autopsy records of the Department of Pathology at Szent László Hospital between 1992-2003 were evaluated fifteen histologically documented cases of mucormycosis. The underlying diseases were hematological malignancy with neutropenia in ten cases, chronic leukaemia with neutropenia, chronic leukaemia with latent diabetes mellitus and diabetes mellitus one case each. Three cases did not belong to any typical risk group. An in vivo diagnosis was made only in four patients with a rhinocerebral manifestation. Radical necrectomy and long-term antifungal therapy cured two of them. Two patients died of a generalised infection despite therapy. None of the systemic infections could be cured. The diagnosis was made post mortem in eleven patients. Selected clinical forms of mucormycosis are illustrated with short case reports.
近年来,侵袭性真菌感染的临床重要性显著增加。毛霉病是一种由毛霉目丝状真菌引起的罕见、危及生命的机会性疾病。毛霉病最常发生在酮症酸中毒糖尿病患者和急性白血病的中性粒细胞减少患者中。本研究对15例患者进行,旨在评估侵袭性毛霉病的临床特征,目标还包括提出早期诊断和治疗方法,因为只有通过积极的手术和抗真菌治疗才能提高生存率。通过对圣拉兹洛医院病理科1992年至2003年间活检和尸检记录的回顾性分析,评估了15例组织学确诊的毛霉病病例。基础疾病为10例伴有中性粒细胞减少的血液系统恶性肿瘤、1例伴有中性粒细胞减少的慢性白血病、1例伴有潜伏性糖尿病的慢性白血病和1例糖尿病。3例不属于任何典型风险组。仅4例有鼻脑表现的患者进行了体内诊断。根治性坏死切除术和长期抗真菌治疗使其中2例治愈。2例患者尽管接受了治疗仍死于全身感染。所有全身感染均未治愈。11例患者在死后确诊。通过简短的病例报告展示了毛霉病的特定临床形式。