Malhotra Shalini, Duggal Shalini, Bhatia Nirmaljeet Kaur, Sharma Nishi, Hans Charoo
Department of Microbiology, Dr Ram Manohar Lohia Hospital, New Delhi, India.
Department of Otorhinolaryngology, Dr Ram Manohar Lohia Hospital, New Delhi, India.
J Med Microbiol. 2009 Jan;58(Pt 1):146-150. doi: 10.1099/jmm.0.005272-0.
Zygomycosis and aspergillosis are two serious opportunistic fungal infections that are commonly seen in immunocompromised patients. Since both these fungi invade vessels of the arterial system, an early and rapid diagnosis by direct examination of KOH mounts of the relevant clinical sample can confirm the diagnosis. Here, we present an unusual case of a diabetic patient who presented with nasal blockade and bleeding for 2 months, along with occasional haemoptysis for 15 days. On investigation, the patient was diagnosed with a case of rhinocerebral zygomycosis and was treated with amphotericin B (1 mg kg(-1) day(-1)), which was subsequently replaced with liposomal amphotericin B (2 mg kg(-1) day(-1)). However, the patient did not completely respond to therapy as haemoptysis continued. Further investigations revealed the presence of Aspergillus flavus in respiratory specimens. Thus, a final diagnosis of rhinocerebral zygomycosis with pulmonary aspergillosis in a non-HIV-infected patient was made, but due to infection of two vital sites by these fungi, the patient could not be saved.
接合菌病和曲霉病是两种严重的机会性真菌感染，常见于免疫功能低下的患者。由于这两种真菌都会侵袭动脉系统的血管，通过直接检查相关临床样本的氢氧化钾涂片进行早期快速诊断可以确诊。在此，我们报告一例不寻常的病例，一名糖尿病患者出现鼻塞和鼻出血2个月，伴有偶尔咯血15天。经检查，该患者被诊断为鼻脑型接合菌病，并接受两性霉素B（1毫克/千克/天）治疗，随后换用脂质体两性霉素B（2毫克/千克/天）。然而, 由于咯血持续，患者对治疗未完全反应。进一步检查发现呼吸道标本中存在黄曲霉。因此，最终诊断为一名非HIV感染患者患有鼻脑型接合菌病合并肺曲霉病，但由于这两种真菌感染了两个重要部位，患者未能挽救。
