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接合菌病——印度的一例病例报告及该病概述

Zygomycosis--a case report and overview of the disease in India.

作者信息

Diwakar Amit, Dewan R K, Chowdhary Anuradha, Randhawa H S, Khanna Geetika, Gaur S N

机构信息

Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, New Delhi, India.

出版信息

Mycoses. 2007 Jul;50(4):247-54. doi: 10.1111/j.1439-0507.2007.01382.x.

Abstract

A case of zygomycosis caused by Rhizopus oryzae in a diabetic patient previously misdiagnosed as invasive pulmonary aspergillosis and an overview of the disease in India are presented. The case was diagnosed by direct microscopy, histopathologic examination and culture. Following surgical resection of pulmonary cavity under cover of amphotericin B administration, the patient recovered completely. Of 461 cases reported to-date, approximately 70% had been diagnosed at the Postgraduate Institute of Medical Education and Research, Chandigarh, in north India. This may be attributed to better awareness, expertise and infrastructural facilities for mycological diagnosis than to any particular regional preponderance of the disease. Rhino-orbito-cerebral manifestations were the most common feature of zygomycosis (269 cases), followed by cutaneous disease (66 cases), which is in conformity with the pattern prevalent worldwide. The etiologic agents encountered were Rhizopus oryzae, Apophysomyces elegans, Saksenaea vasiformis, Cunninghamella bertholletiae, Absidia corymbifera, Basidiobolus ranarum and Conidiobolus coronatus. In contrast to cases from the developed world where transplant recipients and patients with haematological malignancies seem to be most vulnerable to zygomycosis, the most common risk factor in India was uncontrolled diabetes mellitus. Amphotericin B was the mainstay of various treatment modalities employed. The relevance of a strong clinical suspicion and early diagnosis of zygomycosis for favourable prognosis can hardly be over-emphasised.

摘要

本文介绍了一例由米根霉引起的接合菌病病例,该糖尿病患者此前被误诊为侵袭性肺曲霉病,并对印度的这种疾病进行了概述。该病例通过直接显微镜检查、组织病理学检查和培养得以确诊。在两性霉素B治疗的掩护下对肺空洞进行手术切除后,患者完全康复。在迄今为止报告的461例病例中,约70%是在印度北部昌迪加尔的医学教育与研究研究生院确诊的。这可能归因于对真菌学诊断有更高的认识、专业知识和基础设施,而非该疾病在任何特定地区的优势。鼻眶脑型表现是接合菌病最常见的特征(269例),其次是皮肤疾病(66例),这与全球流行的模式一致。所遇到的病原体有米根霉、雅致犁头霉、血管壶菌、柏氏小克银汉霉、伞枝犁头霉、蛙粪霉和冠状耳霉。与发达国家的病例不同,在发达国家移植受者和血液系统恶性肿瘤患者似乎最易患接合菌病,而在印度最常见的危险因素是未控制的糖尿病。两性霉素B是所采用的各种治疗方式的主要药物。对于良好预后而言,强烈的临床怀疑和接合菌病的早期诊断的相关性再怎么强调也不为过。

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