Boelaert J R, Fenves A Z, Coburn J W
Unit for Renal and Infectious Diseases, Algemeen Ziekenhuis St Jan, Brugge, Belgium.
Am J Kidney Dis. 1991 Dec;18(6):660-7. doi: 10.1016/s0272-6386(12)80606-8.
Fifty-nine cases of mucormycosis in dialysis patients have been reported to the registry (25 new cases and 34 previously reported cases). The presenting forms of mucormycosis included disseminated in 44%, rhinocerebral in 31%, and other forms in 25%. The diagnosis was made during life in only 39%, while the diagnosis was discovered at autopsy in 61% of the cases. The fungus, cultured in only 36%, was always Rhizopus. The infection was fatal in 86% of cases. No known risk factors for fungal infections, eg, diabetes mellitus, liver disease, splenectomy, neutropenia, steroid therapy, or other immunosuppressive therapy, were present in 70% of patients, but 78% of patients were being treated with deferoxamine. The role played by this drug and more particularly by its iron chelate, feroxamine, in the pathogenesis of mucormycosis in these patients is underscored. Because of this risk, deferoxamine therapy in dialysis patients should be limited to severe aluminum toxicity, the deferoxamine should be given at the lowest possible dose, and dialytic methods to augment the removal of feroxamine should be studied.
已有59例透析患者的毛霉菌病病例报告至登记处（25例新病例和34例既往报告病例）。毛霉菌病的呈现形式包括播散型占44%，鼻脑型占31%，其他形式占25%。仅39%的病例在生前作出诊断，而61%的病例在尸检时才发现诊断。仅36%的病例培养出真菌，且均为根霉菌。86%的病例感染致死。70%的患者不存在已知的真菌感染危险因素，如糖尿病、肝病、脾切除术、中性粒细胞减少、类固醇治疗或其他免疫抑制治疗，但78%的患者正在接受去铁胺治疗。强调了该药物尤其是其铁螯合物去铁敏在这些患者毛霉菌病发病机制中所起的作用。鉴于这种风险，透析患者的去铁胺治疗应限于严重铝中毒，应给予尽可能低的剂量，并应研究增强去铁敏清除的透析方法。
