Department of College of Pharmacy, The University of Houston, TX 77030, USA.
Clin Infect Dis. 2012 Feb;54 Suppl 1:S67-72. doi: 10.1093/cid/cir884.
Over the last decade, advances in diagnostic systems and the introduction of new antifungal agents have significantly improved outcomes in immunocompromised patients who develop invasive aspergillosis. However, mortality rates remain relatively unchanged for less common, but highly aggressive, mold infections such as mucormycosis. Recent genome sequencing of Rhizopus oryzae revealed evidence of a whole-genome duplication event during the evolution of this pathogen. Consequently, R. oryzae has a 2- to 10-fold enrichment in gene families associated with ergosterol and cell wall biosynthesis, cell growth, iron uptake, and known fungal virulence factors compared with sequenced Aspergillus fumigatus strains. This genetic plasticity may explain the remarkable capability of this pathogen for rapid growth in hostile environments, such as the inflammatory milieu, as well as its relative resistance to multiple antifungal classes. Herein, we examine how pharmacological aspects of treating mucormycosis may differ from those of the more commonly encountered invasive aspergillosis.
在过去的十年中，诊断系统的进步和新型抗真菌药物的引入显著改善了免疫功能低下患者发生侵袭性曲霉病的预后。然而，对于较为罕见但侵袭性很强的霉菌感染，如毛霉菌病，死亡率仍然相对不变。最近对稻根霉的基因组测序揭示了该病原体进化过程中全基因组复制事件的证据。因此，与已测序的烟曲霉菌株相比，稻根霉与麦角固醇和细胞壁生物合成、细胞生长、铁摄取以及已知真菌毒力因子相关的基因家族富集了 2 到 10 倍。这种遗传可塑性可能解释了该病原体在恶劣环境（如炎症环境）中快速生长的惊人能力，以及其对多种抗真菌药物类别的相对耐药性。本文中，我们探讨了治疗毛霉菌病的药理学方面可能与更常见的侵袭性曲霉病有所不同。
