Arworn Supapong, Reanpang Termpong, Apichartpiyakul Poon, Orrapin Saranat, Rerkasem Kittipan
Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
NCD Center of Excellence, Research Institute of Health Science, Chiang Mai University, Chiang Mai, Thailand.
Int J Low Extrem Wounds. 2023 Nov 28:15347346231214291. doi: 10.1177/15347346231214291.
Pythiosis is an infectious disease in humans and animals caused by an aquatic fungus-like micro-organism, . Vascular pythiosis is a difficult condition to treat and can lead to loss of limb in addition to being a potentially life-threatening infection. The condition is furthermore unfamiliar among healthcare workers, which often results in delayed treatment or even misdiagnosis. In this study, we report our findings, which have been gathered over a 20-year period in caring for vascular pythiosis in Maharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand. We made a retrospective medical review of 32 patients presented with arterial occlusion who have serum anti- antibodies. All patients underwent computed tomography angiography to confirm the level of arterial occlusion and decided on a treatment plan. Twelve out of 22 patients with infrainguinal disease, femoropopliteal or below-knee vascular occlusion, survived. The mean survival time is 6.58 years. Eight in 10 patients presented with suprainguinal disease died during the follow-up with a mean survival time of 31.6 months. The suprainguinal extension of the disease influenced the outcome, resulting in a higher mortality rate. However, patients presented with chronic limb ischemia had a much greater rate of survival compared to other clinical presentations. Extensive surgical resection combined with antifungal treatment and immunotherapy have proven to be effective in patients with vascular pythiosis in our findings.
芽生菌病是一种人和动物的传染病，由一种水生真菌样微生物引起。血管芽生菌病是一种难以治疗的疾病，除了可能危及生命的感染外，还可能导致肢体丧失。此外，医护人员对这种疾病并不熟悉，这往往导致治疗延迟甚至误诊。在本研究中，我们报告了在泰国清迈玛哈拉吉·纳空清迈医院护理血管芽生菌病20年期间收集的研究结果。我们对32例有血清抗抗体且出现动脉闭塞的患者进行了回顾性医学检查。所有患者均接受计算机断层扫描血管造影以确认动脉闭塞程度并确定治疗方案。22例患有股腘以下疾病（股腘或膝下血管闭塞）的患者中有12例存活。平均生存时间为6.58年。10例患有腹股沟上疾病的患者中有8例在随访期间死亡，平均生存时间为31.6个月。疾病的腹股沟上扩展影响了预后，导致更高的死亡率。然而，与其他临床表现相比，患有慢性肢体缺血的患者生存率要高得多。我们的研究结果表明，广泛的手术切除联合抗真菌治疗和免疫疗法对血管芽生菌病患者有效。
