鼻眶脑毛霉病：病因病理生理学、临床特征、转归，以及与转归相关的因素。

Rhino-orbito-cerebral Mucormycosis: Etiopathology, Clinical Features, Outcome, and the Factors Associated with Outcome.

机构信息

Department of Ophthalmology, Jawaharlal Institute Postgraduate Medical Education and Research, Puducherry, India.

Department of Microbiology, Jawaharlal Institute Postgraduate Medical Education and Research, Puducherry, India.

出版信息

Korean J Ophthalmol. 2022 Aug;36(4):356-365. doi: 10.3341/kjo.2022.0037. Epub 2022 Jun 15.

DOI:10.3341/kjo.2022.0037

PMID:35766047

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9388891/

Abstract

PURPOSE

Mucormycosis is a multisystemic, aggressive, and an opportunistic fungal infection. The most common type is rhino-orbito-cerebral mucormycosis (ROCM) accounting for almost 40% of the cases. In this study, we analyzed the etiopathology, clinical features, treatment outcome, and the factors associated with outcome in ROCM.

METHODS

Case records of 52 patients of ROCM were analyzed. Clinical parameters, laboratory parameters, imaging findings, treatment regime, and treatment outcome details were retrieved from each case record. The outcome measures were evaluated as treatment success and treatment failure. Univariate and logistic regression analyses were performed to identify factors associated with treatment outcome.

RESULTS

On univariate analysis, factors associated with poor treatment outcome were uncontrolled blood sugar, blood urea, diabetic ketoacidosis, duration of ocular symptoms, no perception of light at presentation, ptosis, conjunctival chemosis, relative afferent pupillary defect, two or more sinus involvement, bony erosion of orbital wall, intracranial extension, intraconal invasion, etc. On subsequent logistic regression analysis, factors that maintained significant association with poor treatment outcome were uncontrolled blood sugar (adjusted odds ratio [aOR], 1.17; p = 0.018), no perception of light at presentation (aOR, 10.67; p = .006), ptosis at presentation (aOR, 3.90; p = 0.03), conjunctival chemosis (aOR, 7.11; p = 0.024), relative afferent pupillary defect (aOR, 10.60, p = 0.01), central retinal artery occlusion at presentation (aOR, 3.54; p = 0.021) and two or more sinus involvement (aOR, 4.90; p = 0.009).

CONCLUSIONS

The current study identified newer factors in the form of presenting ocular and radiological features as predictors for aggressive systemic disease and poor treatment outcome. Future prospective studies are, however, needed to substantiate these associations.

摘要

目的

毛霉菌病是一种全身性、侵袭性和机会性真菌感染。最常见的类型是鼻-眶-脑毛霉菌病（ROCM），占病例的近 40%。在本研究中，我们分析了 ROCM 的病因病理学、临床特征、治疗结果以及与结果相关的因素。

方法

分析了 52 例 ROCM 患者的病例记录。从每份病例记录中检索了临床参数、实验室参数、影像学发现、治疗方案和治疗结果的详细信息。将疗效评估为治疗成功和治疗失败。进行了单变量和逻辑回归分析，以确定与治疗结果相关的因素。

结果

在单变量分析中，与治疗效果不佳相关的因素包括血糖控制不佳、血尿素氮升高、糖尿病酮症酸中毒、眼部症状持续时间、就诊时无光感、上睑下垂、结膜水肿、相对性传入性瞳孔缺陷、两个或更多鼻窦受累、眼眶壁骨侵蚀、颅内延伸、眶内侵犯等。在随后的逻辑回归分析中，与治疗效果不佳仍保持显著相关性的因素包括血糖控制不佳（调整后的优势比[aOR]，1.17；p=0.018）、就诊时无光感（aOR，10.67；p=0.006）、就诊时下睑下垂（aOR，3.90；p=0.03）、结膜水肿（aOR，7.11；p=0.024）、相对性传入性瞳孔缺陷（aOR，10.60，p=0.01）、中央视网膜动脉阻塞就诊时（aOR，3.54；p=0.021）和两个或更多鼻窦受累（aOR，4.90；p=0.009）。