Trief Danielle, Gray Stacey T, Jakobiec Frederick A, Durand Marlene L, Fay Aaron, Freitag Suzanne K, Lee N Grace, Lefebvre Daniel R, Holbrook Eric, Bleier Benjamin, Sadow Peter, Rashid Alia, Chhabra Nipun, Yoon Michael K
Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA.
Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.
Br J Ophthalmol. 2016 Feb;100(2):184-8. doi: 10.1136/bjophthalmol-2015-306945. Epub 2015 Jun 25.
BACKGROUND/AIMS: Invasive fungal infections of the head and neck are rare life-threatening infections where prompt diagnosis and intervention is critical for survival. The aim of this study is to determine the clinical characteristics and outcomes of invasive fungal disease of the sinus and orbit, and to compare mucormycosis and Aspergillus infection.
A retrospective review was conducted from a single tertiary care eye and ear hospital over 20 years (1994-2014). Twenty-four patients with a confirmed pathological diagnosis of invasive fungal disease of the sinus and/or orbit were identified and their medical records were reviewed. The main outcome measures were type of fungus, location of disease, mortality and visual outcome.
Patients with orbital involvement had a higher mortality and higher likelihood of mucormycosis infection compared with those with sinus-only disease (78.6% vs 20%, p=0.01; 86% vs 30%, p=0.01, respectively). Patients with mucormycosis had a higher mortality (71%) than patients with Aspergillus (29%); however, this was not statistically significant (p=0.16). All patients with orbital involvement and/or mucormycosis infections were immunosuppressed or had inadequately controlled diabetes, and had a cranial neuropathy or ocular motility dysfunction. All five post-transplant patients with orbital infections died, while the two transplant patients with sinus infections survived.
Patients with orbital fungal infections are more likely to be infected with mucormycosis compared with Aspergillus and have a higher mortality compared with infections sparing the orbit. History of transplant portends a dismal prognosis in orbital infections. Invasive fungal disease should be considered in any immunocompromised patient presenting with a new cranial neuropathy or ocular motility abnormality.
背景/目的：头颈部侵袭性真菌感染是罕见的危及生命的感染，及时诊断和干预对生存至关重要。本研究的目的是确定鼻窦和眼眶侵袭性真菌病的临床特征和结局，并比较毛霉菌病和曲霉菌感染。
对一家三级眼耳专科医院20年（1994 - 2014年）的数据进行回顾性分析。确定24例经病理确诊的鼻窦和/或眼眶侵袭性真菌病患者，并查阅其病历。主要观察指标为真菌类型、疾病部位、死亡率和视力结局。
与仅累及鼻窦的患者相比，累及眼眶的患者死亡率更高，毛霉菌病感染的可能性更大（分别为78.6%对20%，p = 0.01；86%对30%，p = 0.01）。毛霉菌病患者的死亡率（71%）高于曲霉菌病患者（29%）；然而，差异无统计学意义（p = 0.16）。所有累及眼眶和/或毛霉菌病感染的患者均免疫抑制或糖尿病控制不佳，并有颅神经病变或眼球运动功能障碍。所有5例眼眶感染的移植后患者死亡，而2例鼻窦感染的移植患者存活。
与曲霉菌感染相比，眼眶真菌感染患者更易感染毛霉菌病，与未累及眼眶的感染相比死亡率更高。移植史预示眼眶感染预后不良。任何出现新发颅神经病变或眼球运动异常的免疫受损患者均应考虑侵袭性真菌病。
