Department of Dermatology and Venereology, Peking University First Hospital, Beijing, China.
Research Center for Medical Mycology, Peking University, Beijing, China.
Mycopathologia. 2022 Feb;187(1):1-14. doi: 10.1007/s11046-021-00607-4. Epub 2021 Dec 2.
Mucormycosis is a lethal fungal infection with increasing incidence. The epidemiology of mucormycosis in current mainland China has not been fully elucidated.
To investigate the epidemiology, risk factors, manifestations, diagnosis, treatment and prognosis of mucormycosis in mainland China.
We searched for published mucormycosis case reports/series in mainland China in the PubMed, WanFang and China National Knowledge Infrastructure databases from January 2001 to July 2020. Cases of proven/probable mucormycosis were included.
A total of 390 cases were included in this review. Most of the patients were male (61.3%), and diabetes was the most common predisposing factor (37.2%). Pulmonary mucormycosis (42.1%) was the most common form followed by cutaneous infection (21.0%). Of 390 patients, 24 died before therapy. Among the remaining 366 patients, 208 (56.8%) received antifungal drugs alone, 16 (4.4%) received surgery alone, and 142 (38.8%) received a combination of drugs and surgery, the mortality of the last group is much lower (34/142, 23.9%). The overall mortality was 37.2%. A multivariate analysis indicated that factors associated with increased mortality included corticosteroid use alone as immunosuppressive therapy, rhino-orbito-cerebral or disseminated mucormycosis (compared with pulmonary mucormycosis), and drug administration other than amphotericin B (AmB), posaconazole (POS) and itraconazole (ITR) (compared with the use of conventional AmB), while factors associated with decreased mortality included cutaneous mucormycosis and surgical therapy. Combination or sequential antifungal therapy of AmB and POS or ITR did not reduce mortality compared with conventional AmB monotherapy.
In mainland China, mucormycosis is a serious fungal infection with high mortality. Corticosteroid use, rhino-orbito-cerebral and disseminated mucormycosis were adverse prognostic factors. Antifungal therapy combined with surgery could improve the prognosis.
毛霉病是一种致死性真菌感染，发病率呈上升趋势。目前中国大陆毛霉病的流行病学尚未完全阐明。
调查中国大陆毛霉病的流行病学、危险因素、临床表现、诊断、治疗和预后。
我们在 PubMed、万方和中国知网数据库中检索了 2001 年 1 月至 2020 年 7 月期间发表的中国大陆毛霉病病例报告/系列研究。纳入确诊/疑似毛霉病的病例。
本综述共纳入 390 例病例。大多数患者为男性（61.3%），糖尿病是最常见的易患因素（37.2%）。肺毛霉病（42.1%）是最常见的类型，其次是皮肤感染（21.0%）。390 例患者中，24 例在治疗前死亡。在其余 366 例患者中，208 例（56.8%）单独接受抗真菌药物治疗，16 例（4.4%）单独接受手术治疗，142 例（38.8%）接受药物联合手术治疗，后一组死亡率明显较低（34/142，23.9%）。总的死亡率为 37.2%。多因素分析表明，增加死亡率的因素包括单独使用皮质类固醇作为免疫抑制治疗、鼻-眶-脑或播散性毛霉病（与肺毛霉病相比），以及使用两性霉素 B（AmB）、泊沙康唑（POS）和伊曲康唑（ITR）以外的药物（与使用常规 AmB 相比），而降低死亡率的因素包括皮肤毛霉病和手术治疗。与常规 AmB 单药治疗相比，AmB 和 POS 或 ITR 的联合或序贯抗真菌治疗并未降低死亡率。
在中国大陆，毛霉病是一种严重的真菌感染，死亡率较高。皮质类固醇的使用、鼻-眶-脑和播散性毛霉病是不良预后因素。抗真菌治疗联合手术可以改善预后。
