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第一部分:毛霉菌病:患病率、危险因素、临床特征和诊断。

Part 1: Mucormycosis: prevalence, risk factors, clinical features, and diagnosis.

机构信息

Division of Pulmonary, Critical Care Medicine, Allergy, and Clinical Immunology, Department of Internal Medicine, The David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.

Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.

出版信息

Expert Rev Anti Infect Ther. 2023 Jul-Dec;21(7):723-736. doi: 10.1080/14787210.2023.2220964. Epub 2023 Jun 7.

Abstract

INTRODUCTION

Mucormycosis (MCR) is caused by filamentous molds within the Class Zygomycetes and Order Mucorales. Infections can result from inhalation of spores into the nares, oropharynx, or lungs, ingestion of contaminated food or water, or inoculation into disrupted skin or wounds. In developed countries, MCR occurs primarily in severely immunocompromised hosts. In contrast, in developing/low income countries, most cases of MCR occur in persons with poorly controlled diabetes mellitus and some cases in immunocompetent subjects following trauma. Mucormycosis exhibits a propensity to invade blood vessels, leading to thrombosis and infarction of tissue. Mortality rates associated with invasive MCR are high and can exceed 90% with disseminated disease. Mucormycosis can be classified as one of six forms: (1) rhino-orbital-cerebral mucormycosis (ROCM); (2) pulmonary; (3) cutaneous; (4) gastrointestinal or renal (5); disseminated; or (6) uncommon (focal) sites.

AREAS COVERED

The authors discuss the prevalence, risk factors, and clinical features of mucormycosis. A literature search of mucormycosis was performed via PubMed (up to November 2022), using the key words: invasivefungal infections; mold; mucormycosis;Mucorales; Zyzomyces; Zygomycosis; Rhizopus, diagnosis.

EXPERT OPINION

Mucormycosis occurs primarily in severely immunocompromised hosts. Mucormycosis can progress rapidly, and delay in initiating treatment by even a few days worsens outcomes.

摘要

简介

毛霉病(MCR)由接合菌门毛霉目真菌引起。感染可源于孢子吸入鼻腔、口咽或肺部,摄入污染的食物或水,或接种于破损的皮肤或伤口。在发达国家,MCR 主要发生于严重免疫功能低下的宿主。相比之下,在发展中国家/低收入国家,大多数 MCR 病例发生于糖尿病控制不佳的患者,部分免疫功能正常的患者在创伤后也会发生。毛霉病易侵犯血管,导致血栓形成和组织梗死。侵袭性 MCR 相关死亡率高,播散性疾病的死亡率超过 90%。毛霉病可分为六种类型:(1)鼻-眶-脑毛霉病(ROCM);(2)肺部;(3)皮肤;(4)胃肠道或肾脏(5);播散性;或(6)不常见(局灶性)部位。

涵盖领域

作者讨论了毛霉病的流行率、危险因素和临床特征。通过 PubMed 进行了毛霉病的文献检索(截至 2022 年 11 月),使用的关键词为:侵袭性真菌感染;霉菌;毛霉病;毛霉目;毛霉属;接合菌病;根霉,诊断。

专家意见

毛霉病主要发生于严重免疫功能低下的宿主。毛霉病进展迅速,即使仅延迟几天开始治疗也会使预后恶化。

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