Robin Christine, Alanio Alexandre, Cordonnier Catherine
aHematology Department, Henri Mondor Teaching Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP) bParis-Est Créteil University (UPEC), Créteil cParasitology-Mycology Laboratory, Groupe hospitalier Lariboisière Saint-Louis Fernand Widal dUniversité Paris-Diderot, Sorbonne Paris Cité eInstitut Pasteur, Unité de mycologie moléculaire, CNRS URA3012, Centre National de Référence Mycoses invasives et Antifongiques, Paris, France.
Curr Opin Hematol. 2014 Nov;21(6):482-90. doi: 10.1097/MOH.0000000000000082.
This study focuses on the epidemiology and management of mucormycosis in hematopoietic stem cell transplant patients, a life-threatening mold infection whose incidence has increased over the past decades.
Mucormycosis may occur in hematopoietic stem cell transplant recipients with severe graft-versus-host disease, steroids, neutropenia, iron overload, diabetes, and malnutrition, or those who received antifungals not active against Mucorales. Its incidence in allogeneic hematopoietic stem cell transplant is around 0.3%. As Mucorales are not susceptible to voriconazole and candins, and as mucormycosis often mimics aspergillosis, it is extremely important to have a precise diagnostic to correctly manage the patient. The reversed halo sign on chest computed tomography has been associated to mucormycosis in neutropenic patients, but is not pathognomonic. Direct fungal identification is crucial. Molecular approaches are developed that may be extremely useful for early diagnosis.
Although randomized trials are quite impossible to run, due to the rarity of the disease, the recent numerous data have allowed the elaboration of European guidelines for the management of mucormycosis. Lipid formulations of amphotericin B, and especially liposomal amphotericin B at high doses (5-10 mg/kg/day), are the standard treatment, combined with surgery and control of favoring factors. The prognosis is poor, and any delay in the initiation of therapy may impact on outcome.
本研究聚焦于造血干细胞移植患者毛霉菌病的流行病学及管理，毛霉菌病是一种危及生命的霉菌感染，在过去几十年中其发病率有所上升。
毛霉菌病可能发生在患有严重移植物抗宿主病、使用类固醇、中性粒细胞减少、铁过载、糖尿病和营养不良的造血干细胞移植受者中，或发生在接受对毛霉目无效的抗真菌药物治疗的患者中。其在异基因造血干细胞移植中的发病率约为0.3%。由于毛霉目对伏立康唑和棘白菌素不敏感，且毛霉菌病常类似曲霉病，因此进行精确诊断以正确管理患者极为重要。胸部计算机断层扫描上的反晕征与中性粒细胞减少患者的毛霉菌病有关，但并非特异性表现。直接真菌鉴定至关重要。已开发出分子方法，可能对早期诊断极为有用。
尽管由于该疾病罕见，进行随机试验不太可能，但最近的大量数据已促成了欧洲毛霉菌病管理指南的制定。两性霉素B的脂质制剂，尤其是高剂量（5 - 10毫克/千克/天）的脂质体两性霉素B，是标准治疗方法，同时结合手术及控制诱发因素。预后较差，治疗开始的任何延迟都可能影响结局。
