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免疫功能正常宿主的慢性鼻眶毛霉菌病:一例报告

Chronical rhino-orbital mucormycosis in an immunocompetent host: A case report.

作者信息

Razem Bahaa, Dennai Yassine, Slimani Faiçal

机构信息

Service de Stomatologie et chirurgie Maxillo-faciale, Hôpital 20 Août, CHU Ibn Rochd, B.P 2698, Casablanca, Morocco.

Service de Stomatologie et chirurgie Maxillo-faciale, Hôpital 20 Août, CHU Ibn Rochd, B.P 2698, Casablanca, Morocco.

出版信息

Int J Surg Case Rep. 2021 May;82:105882. doi: 10.1016/j.ijscr.2021.105882. Epub 2021 Apr 10.

Abstract

Mucormycosis is an opportunistic fungal infection caused by molds within the order Mucorales. The rhino-orbital-cerebral localization is the most frequent. It is a destructive, necrotizing and potentially fatal disease. The treatment involves aggressive surgical debridement combined with antifungal drugs. The course is quickly fatal in the event of delayed diagnosis and / or treatment. This infection usually affects immunocompromised and diabetic patients, but cases of mucormycosis in immunocompetents are increasingly reported. Chronic mucormycosis is extremely rare and affects both immunocompromised and immunocompetent patients, its clinical evolution is nonspecific and its treatment is not standardized. We report the case of a destructive rhino-orbital and pulmonary involvement in a 59 years old immunocompetent patient who presented a right periorbital edema associated and a vision loss and a notion of nasal obstruction and progressive onset headache four months before admission. Her condition progressed with rapidly extensive necrosis. She underwent extensive surgical resection but soon succumbed to multiple organ failure. The diagnosis of mucormycosis was confirmed post mortem on the excisional piece. The purpose of this article is to draw attention to chronic mucormycosis in the immunocompetent and to emphasize the importance of early diagnosis and adequate management of this fatal infection.

摘要

毛霉病是一种由毛霉目霉菌引起的机会性真菌感染。鼻眶脑型是最常见的类型。它是一种具有破坏性、坏死性且可能致命的疾病。治疗方法包括积极的手术清创结合抗真菌药物。如果诊断和/或治疗延迟,病程会迅速致命。这种感染通常影响免疫功能低下和糖尿病患者,但免疫功能正常者患毛霉病的病例报告也越来越多。慢性毛霉病极为罕见,可影响免疫功能低下和免疫功能正常的患者,其临床进展不具有特异性,治疗也不规范。我们报告一例59岁免疫功能正常患者出现鼻眶破坏性病变及肺部受累的病例,该患者在入院前四个月出现右侧眶周水肿、视力丧失、鼻塞和进行性头痛。其病情进展迅速,出现广泛坏死。她接受了广泛的手术切除,但很快死于多器官功能衰竭。死后对切除组织进行检查确诊为毛霉病。本文旨在引起对免疫功能正常者慢性毛霉病的关注,并强调早期诊断和妥善处理这种致命感染的重要性。

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