Veterans Affairs Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, USA.
Curr Infect Dis Rep. 2007 Nov;9(6):435-40. doi: 10.1007/s11908-007-0066-4.
Zygomycosis occurs primarily in immunosuppressed patients and those with diabetes mellitus. Diabetes remains the most common risk factor; however, zygomycosis has increased among transplant recipients and patients with hematologic malignancy. Treatment or prophylaxis with voriconazole seems to be associated with the development of zygomycosis among severely immunosuppressed patients in these latter risk groups. Rhino-orbital-cerebral zygomycosis is the most common manifestation in patients with diabetes mellitus, but transplant recipients and patients with hematologic malignancy are more likely to develop pulmonary infection. Zygomycosis remains difficult to treat and requires a multifaceted approach involving elimination of predisposing factors, surgical debridement, and antifungal therapy. Lipid formulations of amphotericin B are the treatments of choice. The use of posaconazole has been successful in salvage trials but should not be used as first-line therapy until an effective intravenous formulation is available.
接合菌病主要发生于免疫抑制患者和糖尿病患者。糖尿病仍然是最常见的危险因素；然而，在移植受者和血液恶性肿瘤患者中，接合菌病的发病率有所增加。在这些高危人群中的严重免疫抑制患者中，使用伏立康唑治疗或预防似乎与接合菌病的发展有关。鼻-眶-脑型接合菌病是糖尿病患者最常见的表现，但移植受者和血液恶性肿瘤患者更有可能发生肺部感染。接合菌病仍然难以治疗，需要采取多方面的方法，包括消除诱发因素、手术清创和抗真菌治疗。两性霉素 B 的脂质制剂是首选的治疗方法。泊沙康唑在挽救试验中取得了成功，但在有效的静脉制剂问世之前，不应将其用作一线治疗药物。
