Yang Yi-meng, Fang Bao-min, Xu Xiao-mao, Fang Fang, Pan Ming-ming, Zhong Xue-feng, Sun Tie-ying
Department of Respiratory and Critical Care Medicine, Beijing Hospital, Peking University, Beijing 100730, China.
Zhonghua Jie He He Hu Xi Za Zhi. 2013 Aug;36(8):572-6.
To describe the clinical manifestations and diagnosis of pulmonary mucormycosis.
We presented 5 proven diagnosed cases of pulmonary mucormycosis in our hospital and reviewed all proven cases of pulmonary mucormycosis previously reported in mainland China. Publications in the form of case reports and articles between January 1982 and December 2011 were searched from Wan Fang Data and China Hospital Knowledge Database.
Of the 5 patients in our hospital, the main symptoms included cough, fever, and hemoptysis. Two cases were diagnosed by transbronchial lung biopsy (TBLB), 1 by surgery, 1 by CT-guided percutaneous lung biopsy, and 1 by blood culture. Three patients were cured by antifungal chemotherapy alone, 1 was cured by surgery, and 1 died. Forty-six proven diagnosed cases of pulmonary mucormycosis were retrieved from Wan Fang Data and China Hospital Knowledge Database using key word (pulmonary mucormycosis). Of the 51 patients in total, there were 31 males and 20 females, with a mean age of (47 ± 13)years. The most common risk factors for pulmonary mucormycosis were poorly controlled diabetes mellitus (18 cases), administration of immunosuppressants (7 cases), malignancy (5 cases) and kidney diseases (5 cases). Chest CT showed nodules (27 cases), infiltrates (21 cases), and cavities (18 cases). White blood cell count and neutrophil percentage were elevated in 26 patients. Eighteen cases were diagnosed by histological study of transbronchial biopsy or TBLB specimen. The diagnosis was proven with surgical specimen in 15 patients, CT-guided percutaneous lung biopsy specimen in 7 patients, autopsy in 4 patients, skin biopsy in 1 patient, and renal biopsy in one patient. Three cases were diagnosed by pleural effusion cultures and 2 were diagnosed by blood cultures. Administration of low-dose liposomal amphotericin B (AMB) alone or combined with posaconazole in 12 patients were effective and safe. Fourteen patients who had received surgical resection were cured.
There were no specific clinical features of pulmonary mucormycosis. Transbronchial biopsy and CT-guided percutaneous lung biopsy are useful diagnostic tools for pulmonary mucormycosis. Surgical resection and administration of low-dose liposomal AMB alone or combined with posaconazole were all effective and safe.
描述肺毛霉菌病的临床表现及诊断方法。
我们报告了我院确诊的5例肺毛霉菌病病例，并回顾了中国大陆此前报道的所有确诊肺毛霉菌病病例。从万方数据和中国医院知识数据库中检索1982年1月至2011年12月期间以病例报告和文章形式发表的文献。
我院的5例患者中，主要症状包括咳嗽、发热和咯血。2例通过经支气管肺活检（TBLB）确诊，1例通过手术确诊，1例通过CT引导下经皮肺活检确诊，1例通过血培养确诊。3例患者仅通过抗真菌化疗治愈，1例通过手术治愈，1例死亡。使用关键词（肺毛霉菌病）从万方数据和中国医院知识数据库中检索到46例确诊的肺毛霉菌病病例。总共51例患者中，男性31例，女性20例，平均年龄为（47±13）岁。肺毛霉菌病最常见的危险因素是糖尿病控制不佳（18例）、使用免疫抑制剂（7例）、恶性肿瘤（5例）和肾脏疾病（5例）。胸部CT显示结节（27例）、浸润（21例）和空洞（18例）。26例患者白细胞计数和中性粒细胞百分比升高。18例通过经支气管活检或TBLB标本的组织学研究确诊。15例患者通过手术标本确诊，7例通过CT引导下经皮肺活检标本确诊，4例通过尸检确诊，1例通过皮肤活检确诊，1例通过肾活检确诊。3例通过胸腔积液培养确诊，2例通过血培养确诊。12例患者单独使用低剂量脂质体两性霉素B（AMB）或联合泊沙康唑治疗有效且安全。14例接受手术切除的患者治愈。
肺毛霉菌病无特异性临床特征。经支气管活检和CT引导下经皮肺活检是肺毛霉菌病有用的诊断工具。手术切除以及单独使用低剂量脂质体AMB或联合泊沙康唑治疗均有效且安全。
