Chetchotisakd P, Boonma P, Sookpranee M, Pairojkul C
Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand.
Southeast Asian J Trop Med Public Health. 1991 Jun;22(2):268-73.
Rhinocerebral mucormycosis (RCM) is a rare, fulminant fungal infection that usually occurs in diabetic or immunocompromised patients. The mortality rate has been reduced recently with the advent of amphotericin B combined with aggressive surgery. Eleven RCM patients have been treated over the past five years at Srinagarind Hospital. Eight had underlying diabetes, five had renal failure and three of them had both. In eight patients, the diagnosis was established by KOH preparation before histological confirmation. Only two cases revealed positive cultures for Rhizopus spp and Cunninghamella spp. All patients underwent surgical treatments (extensive debridement, 8 cases; sphenoidectomy, 7 cases; ethmoidectomy 8 cases; maxillectomy 5 cases and orbital exenteration, 6 cases). Amphotericin B was administered to all patients as soon as the diagnosis of RCM was made. Only three patients survived. Early diagnosis and cooperation among ophthalmologist, otolaryngologist and physician are the most important factors for the survival of patients with mucormycosis.
鼻脑型毛霉菌病（RCM）是一种罕见的暴发性真菌感染，通常发生于糖尿病患者或免疫功能低下者。随着两性霉素B联合积极手术治疗的出现，其死亡率近来有所降低。在过去五年中，诗里拉吉医院共治疗了11例RCM患者。其中8例有潜在糖尿病，5例有肾衰竭，3例同时患有糖尿病和肾衰竭。8例患者在组织学确诊前通过氢氧化钾制剂确诊。仅2例培养出根霉属和小克银汉霉属阳性。所有患者均接受了手术治疗（广泛清创术8例；蝶窦切除术7例；筛窦切除术8例；上颌骨切除术5例；眼眶内容剜除术6例）。一旦确诊RCM，即对所有患者使用两性霉素B治疗。仅3例患者存活。早期诊断以及眼科医生、耳鼻喉科医生和内科医生之间的合作是毛霉菌病患者存活的最重要因素。
