Kronen Ryan, Liang Stephen Y, Bochicchio Grant, Bochicchio Kelly, Powderly William G, Spec Andrej
Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, 660 S. Euclid Ave., St. Louis, MO, USA.
Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, 660 S. Euclid Ave., St. Louis, MO, USA; Division of Emergency Medicine, Washington University School of Medicine, 660 S. Euclid Ave., St. Louis, MO, USA.
Int J Infect Dis. 2017 Sep;62:102-111. doi: 10.1016/j.ijid.2017.07.002. Epub 2017 Jul 10.
Invasive fungal infection (IFI) is a rare but serious complication of traumatic injury. The purpose of this article is to review the epidemiology, natural history, mycology, risk factors, diagnosis, treatment, and outcomes associated with post-traumatic IFI in military and civilian populations. The epidemiology of post-traumatic IFI is poorly characterized, but incidence appears to be rising. Patients often suffer from severe injuries and require extensive medical interventions. Fungi belonging to the order Mucorales are responsible for most post-traumatic IFI in both civilian and military populations. Risk factors differ between these cohorts but include specific injury patterns and comorbidities. Diagnosis of post-traumatic IFI typically follows positive laboratory results in the appropriate clinical context. The gold standard of treatment is surgical debridement in addition to systemic antifungal therapy. Patients with post-traumatic IFI may be at greater risk of amputation, delays in wound healing, hospital complications, and death as compared to trauma patients who do not develop IFI. More research is needed to understand the factors surrounding the development and management of post-traumatic IFI to reduce the significant morbidity and mortality associated with this disease.
侵袭性真菌感染(IFI)是创伤性损伤中一种罕见但严重的并发症。本文旨在综述军事和 civilian 人群中创伤后IFI的流行病学、自然史、真菌学、危险因素、诊断、治疗及预后。创伤后IFI的流行病学特征尚不明确,但发病率似乎在上升。患者常遭受严重损伤,需要广泛的医疗干预。毛霉目真菌是 civilian 和军事人群中大多数创伤后IFI的致病菌。这些队列中的危险因素有所不同,但包括特定的损伤模式和合并症。创伤后IFI的诊断通常在适当的临床背景下依据实验室检查结果呈阳性做出。治疗的金标准是手术清创加全身抗真菌治疗。与未发生IFI的创伤患者相比,创伤后IFI患者截肢、伤口愈合延迟、医院并发症及死亡的风险可能更高。需要更多研究来了解创伤后IFI发生和管理的相关因素,以降低与该疾病相关的显著发病率和死亡率。 (注:原文中“civilian”未翻译完整,推测可能是“平民”之意,你可根据实际情况修正完善译文)