Roden Maureen M, Zaoutis Theoklis E, Buchanan Wendy L, Knudsen Tena A, Sarkisova Tatyana A, Schaufele Robert L, Sein Michael, Sein Tin, Chiou Christine C, Chu Jaclyn H, Kontoyiannis Dimitrios P, Walsh Thomas J
Pediatric Oncology Branch, National Cancer Institute, Bethesda, MD 20892, USA.
Clin Infect Dis. 2005 Sep 1;41(5):634-53. doi: 10.1086/432579. Epub 2005 Jul 29.
Zygomycosis is an increasingly emerging life-threatening infection. There is no single comprehensive literature review that describes the epidemiology and outcome of this disease.
We reviewed reports of zygomycosis in the English-language literature since 1885 and analyzed 929 eligible cases. We included in the database only those cases for which the underlying condition, the pattern of infection, the surgical and antifungal treatments, and survival were described.
The mean age of patients was 38.8 years; 65% were male. The prevalence and overall mortality were 36% and 44%, respectively, for diabetes; 19% and 35%, respectively, for no underlying condition; and 17% and 66%, respectively, for malignancy. The most common types of infection were sinus (39%), pulmonary (24%), and cutaneous (19%). Dissemination developed in 23% of cases. Mortality varied with the site of infection: 96% of patients with disseminated disease died, 85% with gastrointestinal infection died, and 76% with pulmonary infection died. The majority of patients with malignancy (92 [60%] of 154) had pulmonary disease, whereas the majority of patients with diabetes (222 [66%] of 337) had sinus disease. Rhinocerebral disease was seen more frequently in patients with diabetes (145 [33%] of 337), compared with patients with malignancy (6 [4%] of 154). Hematogenous dissemination to skin was rare; however, 78 (44%) of 176 cutaneous infections were complicated by deep extension or dissemination. Survival was 3% (8 of 241 patients) for cases that were not treated, 61% (324 of 532) for cases treated with amphotericin B deoxycholate, 57% (51 of 90) for cases treated with surgery alone, and 70% (328 of 470) for cases treated with antifungal therapy and surgery. By multivariate analysis, infection due to Cunninghamella species and disseminated disease were independently associated with increased rates of death (odds ratios, 2.78 and 11.2, respectively).
Outcome from zygomycosis varies as a function of the underlying condition, site of infection, and use of antifungal therapy.
接合菌病是一种日益常见的危及生命的感染性疾病。目前尚无全面描述该疾病流行病学及转归的文献综述。
我们回顾了自1885年以来英文文献中关于接合菌病的报道，并分析了929例符合条件的病例。我们仅将那些描述了基础疾病、感染类型、手术及抗真菌治疗情况以及生存情况的病例纳入数据库。
患者的平均年龄为38.8岁；65%为男性。糖尿病患者的患病率和总死亡率分别为36%和44%；无基础疾病患者分别为19%和35%；恶性肿瘤患者分别为17%和66%。最常见的感染类型为鼻窦感染（39%）、肺部感染（24%）和皮肤感染（19%）。23%的病例发生播散。死亡率因感染部位而异：播散性疾病患者的死亡率为96%，胃肠道感染患者为85%，肺部感染患者为76%。大多数恶性肿瘤患者（154例中的92例[60%]）患有肺部疾病，而大多数糖尿病患者（337例中的222例[66%]）患有鼻窦疾病。与恶性肿瘤患者（154例中的6例[4%]）相比，糖尿病患者（337例中的145例[33%]）更常发生鼻脑疾病。血行播散至皮肤较为罕见；然而，176例皮肤感染中有78例（44%）并发深部扩展或播散。未治疗的病例生存率为3%（241例患者中的8例），接受去氧胆酸盐两性霉素B治疗的病例为61%（532例中的324例），仅接受手术治疗的病例为57%（90例中的51例），接受抗真菌治疗及手术的病例为70%（470例中的328例）。多因素分析显示，康宁汉姆菌属感染及播散性疾病与死亡率增加独立相关（比值比分别为2.78和11.2）。
接合菌病的转归因基础疾病、感染部位及抗真菌治疗的应用而异。
