Lakatos Botond, Nikolova Radka, Ocskay László, Csomor Judit, Prinz Gyula
Egyesített Szent István és Szent László Kórház Neuroinfektológiai Osztály Budapest Gyáli út 5-7. 1097.
Orv Hetil. 2010 Sep 26;151(39):1591-6. doi: 10.1556/OH.2010.28969.
Zygomycosis (mucormycosis) is a rare, highly aggressive opportunistic fungal disease caused by saprophytic fungi, belonging to the division Zygomycota, class Zygomycetes. Patients with immunodeficiency, neutropenia, iron overload, hematological malignancies, as well as diabetics with ketoacidosis are typically affected.
Authors describe the case of an eighteen-year old man with poor compliance suffering from diabetes since the age of nine. He was admitted with ketoacidotic somnolence in severe general condition with unilateral periorbital erythematous edema. Though from nasal exudates gained by the fibero-endoscopic sinus surgery Methicillin-resistant Staphylococcus aureus and Pseudomas aeruginosa was cultured, amphotericin-B was administered as the medical history, clinical picture suggested presence of zygomycosis. An invasive infection caused by Rhizopus oryzae was confirmed by histology and microbiology.
The combination of antifungal therapy, repeated surgical interventions and granulocyte colony-stimulating factor resulted in good clinical response. Four month after discharge he is alive and doing well.
接合菌病(毛霉病)是一种罕见的、具有高度侵袭性的机会性真菌病,由属于接合菌门、接合菌纲的腐生真菌引起。免疫缺陷、中性粒细胞减少、铁过载、血液系统恶性肿瘤患者以及患有酮症酸中毒的糖尿病患者通常会受到影响。
作者描述了一名18岁男性的病例,该患者自9岁起患糖尿病,依从性差。他因酮症酸中毒性嗜睡入院,全身状况严重,单侧眶周出现红斑性水肿。尽管通过纤维内镜鼻窦手术获得的鼻分泌物培养出了耐甲氧西林金黄色葡萄球菌和铜绿假单胞菌,但根据病史和临床表现,考虑存在接合菌病,给予两性霉素B治疗。组织学和微生物学证实为米根霉引起的侵袭性感染。
抗真菌治疗、反复手术干预和粒细胞集落刺激因子的联合应用产生了良好的临床反应。出院四个月后,他仍然存活且状况良好。