Vaezi Afsane, Moazeni Maryam, Rahimi Mohammad Taghi, de Hoog Sybren, Badali Hamid
Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran.
Department of Medical Mycology and Parasitology/Invasive Fungi Research Center (IFRC), School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
Mycoses. 2016 Jul;59(7):402-15. doi: 10.1111/myc.12474. Epub 2016 Feb 15.
Fungi in the order Mucorales cause acute, invasive and frequently fatal infections in susceptible patients. This study aimed to perform a systematic review of all reported mucormycosis cases during the last 25 years in Iran. After a comprehensive literature search, we identified 98 cases in Iran from 1990-2015. The mean patient age was 39.8 ± 19.2 years. Diabetes was the most common underlying condition (47.9%), and 22.4% of the patients underwent solid organ or bone marrow transplantation. The most common clinical forms of mucormycosis were rhinocerebral (48.9%), pulmonary (9.2%) and cutaneous (9.2%). Eight cases of disseminated disease were identified. Overall mortality in the identified cases was 40.8%, with the highest mortality rate in patients diagnosed with disseminated infection (75%). The mortality rate in rhinocerebral infection patients was significantly lower (45.8%). Rhinocerebral infection was the most common clinical manifestation in diabetes patients (72.9%). Patients were diagnosed using various methods including histopathology (85.7%), microscopy (12.3%) and culture (2.0%). Rhizopus species were the most prevalent (51.7%), followed by Mucor species (17.2%). Sixty-nine patients were treated with a combination of surgery and antifungal therapy (resulting survival rate, 66.7%). Owing to the high mortality rate of advanced mucormycosis, early diagnosis and treatment may significantly improve survival rates. Therefore, increased monitoring and awareness of this life-threatening disease is critical.
毛霉目真菌可在易感患者中引发急性、侵袭性且常为致命性的感染。本研究旨在对伊朗过去25年中所有报告的毛霉病病例进行系统综述。经过全面的文献检索，我们在伊朗确定了1990年至2015年期间的98例病例。患者的平均年龄为39.8±19.2岁。糖尿病是最常见的基础疾病（47.9%），22.4%的患者接受了实体器官或骨髓移植。毛霉病最常见的临床类型为鼻脑型（48.9%）、肺型（9.2%）和皮肤型（9.2%）。确定了8例播散性疾病病例。所确定病例的总体死亡率为40.8%，播散性感染患者的死亡率最高（75%）。鼻脑型感染患者的死亡率显著较低（45.8%）。鼻脑型感染是糖尿病患者中最常见的临床表现（72.9%）。患者通过多种方法进行诊断，包括组织病理学（85.7%）、显微镜检查（12.3%）和培养（2.0%）。根霉属是最常见的（51.7%），其次是毛霉属（17.2%）。69例患者接受了手术和抗真菌治疗联合方案（生存率为66.7%）。由于晚期毛霉病的高死亡率，早期诊断和治疗可能显著提高生存率。因此，加强对这种危及生命疾病的监测和认识至关重要。
