Department of Otorhinolaryngology, Christian Medical College, Vellore, India.
Department of Microbiology, Christian Medical College, Vellore, India.
Mycoses. 2021 Aug;64(8):882-889. doi: 10.1111/myc.13294. Epub 2021 May 9.
Conidiobolomycosis is a rare tropical rhinofacial fungal infection which has not been well characterised. The available evidence in its management is sparse due to lack of clinical studies and the limited data on antifungal susceptibility patterns.
To analyse the clinical manifestations, antifungal treatment and outcomes of patients with conidiobolomycosis and to determine antifungal susceptibility profiles of the isolates.
PATIENTS/METHODS: Retrospective analysis of data of all patients with a diagnosis of conidiobolomycosis confirmed by histopathology and culture at a tertiary care hospital from 2012 to 2019 was done.
There were 22 patients, 21 males and one female, with a mean age of 37.1 years. Most common presenting symptom was nasal obstruction, found in 20 (90.90%) patients. Patients who presented within 12 months had a better cure rate (85%) compared to those who presented late (67%). Among the 19 patients who had a follow-up, good outcome was seen in 15 of the 17 (88.24%) patients who were on itraconazole or potassium iodide containing regimen. Of the six patients who received additional trimethoprim-sulphamethoxazole (co-trimoxazole), 67% showed good outcome with two patients showing complete cure and two patients still on treatment with significant improvement. High minimum inhibitory concentration (MIC) values were noted for azoles and amphotericin B, whereas co-trimoxazole showed lowest MIC ranges.
Itraconazole and potassium iodide are reasonable first-line options for the treatment of conidiobolomycosis. Good clinical response to KI and comparatively lower MIC of co-trimoxazole are promising. Further studies are required for developing clinical breakpoints that can predict therapeutic outcomes.
瓶梗霉病是一种罕见的热带鼻面部真菌感染，其特征尚未得到很好的描述。由于缺乏临床研究和抗真菌药敏模式的数据有限，其管理方面的可用证据很少。
分析瓶梗霉病患者的临床表现、抗真菌治疗和结局，并确定分离株的抗真菌药敏谱。
患者/方法：对 2012 年至 2019 年在一家三级保健医院通过组织病理学和培养确诊为瓶梗霉病的所有患者的数据进行回顾性分析。
共有 22 例患者，21 例男性和 1 例女性，平均年龄为 37.1 岁。最常见的首发症状是鼻塞，20 例（90.90%）患者存在该症状。12 个月内就诊的患者治愈率（85%）高于就诊较晚的患者（67%）。在 19 例有随访的患者中，17 例（88.24%）接受伊曲康唑或含碘化钾的方案治疗的患者预后良好。在接受复方磺胺甲噁唑（复方新诺明）治疗的 6 例患者中，67%的患者预后良好，2 例患者完全治愈，2 例患者仍在治疗中且病情明显改善。唑类和两性霉素 B 的最低抑菌浓度（MIC）值较高，而复方新诺明的 MIC 范围最低。
伊曲康唑和碘化钾是治疗瓶梗霉病的合理一线选择。KI 的良好临床反应和相对较低的复方新诺明 MIC 值具有很大的应用前景。需要进一步研究以制定可预测治疗结果的临床折点。
