Van Sickels Nicholas, Hoffman Jordan, Stuke Lance, Kempe Kelly
Section of Infectious Diseases, Department of Internal Medicine, Tulane University School of Medicine, New Orleans, Louisiana 70112, USA.
J Trauma. 2011 Feb;70(2):507-9. doi: 10.1097/TA.0b013e31820784ff.
Mucormycosis is a deadly angioinvasive fungal infection that is increasing in incidence. Gastrointestinal and abdominal involvement is rare, has higher mortality rates, and is frequently diagnosed late.
We report a patient who sustained multiple gunshot wounds to the chest and abdomen and subsequently developed omental and hepatic mucormycosis. He underwent 14 abdominal washouts and several liver debridements, and he received combination therapy with amphotericin B and micafungin.
The patient survived the disease, with negative cultures and pathology at the last washout, and underwent skin grafting. He is clinically improved and remains on oral antifungals as an outpatient.
Mucormycosis should be considered in trauma patients with persistent signs of infection after lavage and antibiotics, especially when necrosis or atypical wound presentations are noted. Approaches such as ours using aggressive surgical management and intensive antifungal administration should be instituted once the diagnosis is suspected.
毛霉菌病是一种致命的血管侵袭性真菌感染，其发病率正在上升。胃肠道和腹部受累情况罕见，死亡率较高，且常常诊断较晚。
我们报告一名胸部和腹部遭受多处枪伤的患者，随后发生了网膜和肝脏毛霉菌病。他接受了14次腹腔冲洗和多次肝脏清创术，并接受了两性霉素B和米卡芬净的联合治疗。
患者从该病中存活下来，最后一次冲洗时培养结果和病理检查均为阴性，并接受了皮肤移植。他的临床症状有所改善，门诊仍在口服抗真菌药物。
对于在冲洗和使用抗生素后仍有持续感染迹象的创伤患者，尤其是当出现坏死或非典型伤口表现时，应考虑毛霉菌病。一旦怀疑诊断，应采用如我们这样积极的手术治疗和强化抗真菌给药等方法。
