Melero M, Kaimen Maciel I, Tiraboschi N, Botargues M, Radisic M
Servicio de Otorrinolaringología, Hospital de Clínicas José de San Martín, Facultad de Medicina, Universidad de Buenos Aires, Argentina.
Medicina (B Aires). 1991;51(1):53-5.
Mucormycosis (phycomycosis) is an acute and often fatal infection, mostly seen in diabetics and immunocompromised patients, and seldom in healthy people. Therapy includes aggressive surgical debridement, amphotericin B and control of underlying predisposing condition (diabetes, immunosuppression or immunodeficiency). The rhino-sinuso-orbital presentation is typically observed in insulin-dependent diabetes mellitus with ketoacidosis. This metabolic condition may impair the polymorphonuclear function in a reversible way and this may favour infection by a mucoral. These spores germinate into hyphae, which invade local arteries and arterioles, causing thrombosis, vascular insufficiency and tissue hypoxia and acidosis, conditions which further enhance fungal growth. Hyperbaric oxygen has theoretical value in treating mucormycosis, since it reduces tissue hypoxia caused by the vascular insufficiency. We report an insulin-dependent diabetic patient with rhino-sinuso-orbital mucormycosis, who after being treated with amphotericin B and surgical debridement on two occasions, maintained clinical and tomographic evidence of active infection, and mucoral persistence in the lesion. An aggressive surgical debridement, using microsurgical techniques, was performed. Amphotericin B was increased up to a total dose of 3900 mg. (he had previously received 2900 mg) and hyperbaric oxygen was added as adjunctive treatment. The outcome was successful. There was no evidence of relapse after a 16-month follow-up. This observation would confirm the usefulness of hyperbaric oxygen as adjunctive therapy in mucormycosis.
毛霉病（藻菌病）是一种急性且常致命的感染，多见于糖尿病患者和免疫功能低下者，在健康人中很少见。治疗方法包括积极的手术清创、两性霉素B以及控制潜在的诱发因素（糖尿病、免疫抑制或免疫缺陷）。鼻-鼻窦-眼眶型表现通常见于胰岛素依赖型糖尿病合并酮症酸中毒患者。这种代谢状况可能以可逆方式损害多形核白细胞功能，这可能有利于毛霉感染。这些孢子萌发成菌丝，侵入局部动脉和小动脉，导致血栓形成、血管功能不全以及组织缺氧和酸中毒，这些状况会进一步促进真菌生长。高压氧在治疗毛霉病方面具有理论价值，因为它可减轻由血管功能不全引起的组织缺氧。我们报告一例胰岛素依赖型糖尿病合并鼻-鼻窦-眼眶毛霉病患者，该患者在接受两次两性霉素B治疗和手术清创后，仍有临床和断层扫描证据显示存在活动性感染，且病变处有毛霉持续存在。遂采用显微外科技术进行了积极的手术清创。两性霉素B总剂量增至3900毫克（此前已接受2900毫克），并加用高压氧作为辅助治疗。治疗结果成功。16个月的随访后未发现复发迹象。这一观察结果将证实高压氧作为毛霉病辅助治疗的有效性。
