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无家可归者的皮肤真菌感染及低资源环境下的治疗:一项范围综述

Cutaneous Fungal Infections in Patients Experiencing Homelessness and Treatment in Low-Resource Settings: A Scoping Review.

作者信息

Rasul Taha F, Gamret A C, Morgan Orly, Bergholz Daniel R, Eachus Emily, Mathew Megan, Faiz Arfa, Elkhadem Adam, Dahl Victoria, Motoa Gabriel, Gulraiz Sana, Henderson Armen, Morrison Brian W

机构信息

Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, USA.

Department of Public Health, University of Miami Miller School of Medicine, Miami, USA.

出版信息

Cureus. 2022 Oct 29;14(10):e30840. doi: 10.7759/cureus.30840. eCollection 2022 Oct.

Abstract

Patients experiencing homelessness (PEH) suffer from a high burden of cutaneous fungal infections. Preventative treatment is important as such infections can lead to harmful complications such as cellulitis and even osteomyelitis. There are sparse data regarding cutaneous fungal infections of homeless populations and management in low-resource settings. A MEDLINE search was conducted using the key terms "cutaneous," "fungal," "infections," "dermatophytes," and "homeless." The search included case-control, cohort, and randomized controlled trials published in the English language. This scoping review of studies yielded information with regard to practical treatment advice for providers in low-resource settings, including medical, hygiene, prevention, and treatment options for PEH with cutaneous fungal infections, the most common of which were tinea pedis (3-38%) and onychomycosis (1.6-15.5%). Few studies have been conducted on the differences between sheltered and unsheltered homeless patients, which can have treatment implications. Systemic antifungal therapy should be carefully considered for diffuse, refractory, or nail-based cutaneous fungal infections if there is a history of alcohol use disorder or liver disease. While PEH have a high risk of alcohol use disorder, this can make definitive treatment challenging.

摘要

无家可归者(PEH)患有皮肤真菌感染的负担很重。预防性治疗很重要,因为此类感染会导致诸如蜂窝织炎甚至骨髓炎等有害并发症。关于无家可归人群的皮肤真菌感染及低资源环境下的管理的数据很少。使用关键词“皮肤的”“真菌的”“感染”“皮肤癣菌”和“无家可归者”进行了MEDLINE搜索。搜索包括以英文发表的病例对照、队列和随机对照试验。这项研究的范围综述为低资源环境下的医疗服务提供者提供了实用的治疗建议信息,包括针对患有皮肤真菌感染的无家可归者的医疗、卫生、预防和治疗选择,其中最常见的是足癣(3%-38%)和甲癣(1.6%-15.5%)。关于有住所和无住所的无家可归患者之间的差异的研究很少,而这可能会对治疗产生影响。如果有酒精使用障碍或肝病病史,对于弥漫性、难治性或指甲部位的皮肤真菌感染,应谨慎考虑全身抗真菌治疗。虽然无家可归者有很高的酒精使用障碍风险,但这可能会使确定性治疗具有挑战性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e136/9704118/19ae8d6b8e78/cureus-0014-00000030840-i01.jpg

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