Rogers Thomas R
Department of Clinical Microbiology, School of Medicine, Trinity College Dublin, St James's Hospital, Dublin 8, Ireland.
J Antimicrob Chemother. 2008 Jan;61 Suppl 1:i35-40. doi: 10.1093/jac/dkm429.
Zygomycosis is a frequently lethal invasive infection in high-risk patients such as the immunocompromised [especially haematopoietic stem cell transplant (HSCT) recipients] and patients with type 2 diabetes mellitus. However, zygomycosis has also been reported in individuals without known risk factors. The causative fungi are members of the order Mucorales and individual species within this group require a high level of laboratory skill for their identification. These organisms are resistant to voriconazole and also to the echinocandins, and although zygomycosis is less commonly documented than invasive aspergillosis in leukaemic and HSCT patients, there are recent reports suggesting that it has increased in incidence since the introduction of voriconazole. Zygomycosis can present clinically as rhinocerebral, pulmonary or disseminated disease which progresses rapidly. The management of cases is based on early diagnosis, surgical debridement when possible and aggressive antifungal therapy. Based on clinical experience, but without the benefit of comparative studies, liposomal amphotericin B has become the therapeutic agent of choice. Posaconazole is a new orally administered triazole antifungal and the first member of this class to have comparable in vitro activity to amphotericin B against most zygomycetes. Studies of salvage therapy of zygomycosis with posaconazole have yielded promising results and there are additional case reports of successful outcomes using these and other antifungal drugs as combination therapy. Adjunctive approaches that are showing promise but with limited clinical experience are iron chelation and immunotherapy.
接合菌病是一种在免疫功能低下者（尤其是造血干细胞移植受者）和2型糖尿病患者等高危患者中常见的致死性侵袭性感染。然而，在无已知危险因素的个体中也有接合菌病的报道。致病真菌属于毛霉目，该类群中的个别菌种需要较高的实验室鉴定技能。这些微生物对伏立康唑和棘白菌素均耐药，尽管在白血病患者和造血干细胞移植患者中，接合菌病的记录不如侵袭性曲霉病常见，但最近有报道表明，自伏立康唑应用以来，其发病率有所上升。接合菌病在临床上可表现为鼻脑型、肺型或播散型疾病，病情进展迅速。病例的处理基于早期诊断、尽可能进行手术清创以及积极的抗真菌治疗。根据临床经验，但缺乏比较研究的支持，脂质体两性霉素B已成为首选治疗药物。泊沙康唑是一种新型口服三唑类抗真菌药，是该类药物中首个在体外对大多数接合菌具有与两性霉素B相当活性的药物。用泊沙康唑进行接合菌病挽救治疗的研究已取得了有前景的结果，还有其他一些病例报告显示，使用这些药物及其他抗真菌药物进行联合治疗取得了成功。显示出前景但临床经验有限的辅助治疗方法包括铁螯合和免疫治疗。
