1st Department of Internal Medicine, University of Cologne, Cologne, Germany.
Crit Rev Microbiol. 2013 Aug;39(3):310-24. doi: 10.3109/1040841X.2012.711741. Epub 2012 Aug 24.
Mucormycosis is an emerging invasive fungal infection, primarily affecting immunocompromised patients. The disease is difficult to diagnose and mortality reaches 40% even if treated adequately. Depending on site of infection and risk factors, surgical debridement in combination with systemically active antifungal drugs are the mainstay treatment strategies. Lipid-based amphotericin B is the treatment of choice for first-line therapy while posaconazole may be a promising alternative. We performed a PubMed search on reports of patients with mucormycosis treated with posaconazole. From 2003 to 2011, 96 cases have been published. Diagnosis was based on histology alone in 2 (2.1%) and microbiological evidence in 67 (69.8%), while no data on the diagnostic approach was reported in 27 (28.1%) patients. The most frequent pathogens were Rhizopus spp. (31.2%), followed by Mucor spp. (14.6%). The site of infection was predominantly rhino-orbital (38.5%, of which 43% also had central nervous system [CNS] involvement), followed by disseminated disease (22.1%). A complete response was achieved in 62 (64.6%), partial response in 7 (7.3%) patients, and stable disease in 1 (1%). Overall mortality was 24% (lacking data for three patients). In published case reports on posaconazole treatment for mucormycosis, the drug was frequently and successfully used in combination or as second line therapy.
毛霉病是一种新兴的侵袭性真菌感染，主要影响免疫功能低下的患者。这种疾病很难诊断，如果治疗不当，死亡率高达 40%。根据感染部位和危险因素，手术清创结合系统有效的抗真菌药物是主要的治疗策略。脂溶性两性霉素 B 是一线治疗的首选药物，而泊沙康唑可能是一种有前途的替代药物。我们在 PubMed 上搜索了使用泊沙康唑治疗毛霉病的患者报告。从 2003 年到 2011 年，已经发表了 96 例病例。诊断依据仅为组织学的有 2 例（2.1%），依据微生物学证据的有 67 例（69.8%），而 27 例（28.1%）患者的诊断方法无数据报道。最常见的病原体是根毛霉属（31.2%），其次是毛霉属（14.6%）。感染部位主要是鼻-眶（38.5%，其中 43%也有中枢神经系统 [CNS] 受累），其次是播散性疾病（22.1%）。62 例（64.6%）患者获得完全缓解，7 例（7.3%）患者获得部分缓解，1 例（1%）患者病情稳定。总死亡率为 24%（3 例患者数据缺失）。在已发表的使用泊沙康唑治疗毛霉病的病例报告中，该药物经常被成功地联合使用或作为二线治疗药物。
