4st Dept. of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, "ATTIKON" Hospital, RIMINI 1 - Haidari, Athens - 12464. Greece.
Mediterr J Hematol Infect Dis. 2011;3(1):e2011012. doi: 10.4084/MJHID.2011.012. Epub 2011 Mar 15.
Zygomycoses caused by fungi of the mucorales order (mucormycoses) are emerging fungal diseases with a high fatality rate. The most important risk factors include neutropenia or functional neutropenia, diabetic ketoacidosis, iron overload, major trauma, prolonged use of corticosteroids, illicit intravenous drug (ID) use, neonatal prematurity, malnourishment, and maybe a previous exposure to antifungal agents with no activity against zygomycetes, such as voriconazole and echinocandins.A high index of suspicion is crucial for the diagnosis, as prompt and appropriate management can considerably reduce morbidity and mortality. Suspicion index can be increased through recognition of the differential patterns of clinical presentation. In the non- haematological immunocompromised patients, mucormycosis can manifest in various clinical forms, depending on the underlying condition: mostly as rhino-orbital or rhino-cerebral in diabetes patients, pulmonary infection in patients with malignancy or solid organ transplantation, disseminated infection in iron overloaded or deferoxamine treated patients, cerebral - with no sinus involvement - in ID users, gastrointestinal in premature infants or malnourishment, and cutaneous after direct inoculation in immunocompetent individuals with trauma or burns.Treating a patient's underlying medical condition and reducing immunosuppression are essential to therapy. Rapid correction of metabolic abnormalities is mandatory in cases such as uncontrolled diabetes, and corticosteroids or other immunosuppressive drugs should be discontinued where feasible. AmphotericinB or its newer and less toxic lipid formulations are the drugs of choice regarding antifungal chemotherapy, while extensive surgical debridement is essential to reduce infected and necrotic tissue. A high number of cases could be prevented through measures including diabetes control programmes and proper pre- and post-surgical hygiene.
接合菌病（接合菌病）是由毛霉目真菌引起的真菌性疾病，具有很高的死亡率。最重要的危险因素包括中性粒细胞减少或功能性中性粒细胞减少、糖尿病酮症酸中毒、铁过载、大创伤、长期使用皮质类固醇、非法静脉内药物（ID）使用、新生儿早产、营养不良，也许以前曾暴露于无抗接合菌活性的抗真菌药物，如伏立康唑和棘白菌素。诊断的关键是高度怀疑，因为及时和适当的治疗可以大大降低发病率和死亡率。怀疑指数可以通过识别临床表现的差异模式来增加。在非血液学免疫功能低下的患者中，接合菌病可表现为多种临床形式，具体取决于基础疾病：在糖尿病患者中主要为鼻-眶或鼻-脑，在恶性肿瘤或实体器官移植患者中为肺部感染，在铁过载或去铁胺治疗的患者中为播散性感染，在 ID 用户中为无窦受累的脑部感染，在早产儿或营养不良的胃肠道感染，在免疫功能正常的个体中，创伤或烧伤后直接接种为皮肤感染。治疗患者的基础医疗状况和降低免疫抑制是治疗的关键。对于未控制的糖尿病等病例，必须迅速纠正代谢异常，并且在可行的情况下应停止使用皮质类固醇或其他免疫抑制药物。两性霉素 B 或其更新、毒性更低的脂质制剂是抗真菌化疗的首选药物，而广泛的外科清创对于减少感染和坏死组织至关重要。通过控制糖尿病计划和适当的术前和术后卫生措施等措施，可以预防大量病例。
