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毛霉菌病:一个棘手的敌人,病例系列

Mucormycosis: A sweet enemy, case series.

作者信息

Manrique-Castaño Santiago, Velásquez-Trujillo Luis Armando, Ángel Correa Mariana, Bravo José Humberto, Matta Cortes Lorena

机构信息

Departamento de Medicina Interna, Escuela de Medicina, Facultad de Salud, Universidad del Valle, Cali, Colombia.

Programa de Medicina y Cirugía, Escuela de Medicina, Facultad de Salud, Universidad del Valle, Cali, Colombia.

出版信息

Biomedica. 2024 May 30;44(2):135-143. doi: 10.7705/biomedica.7120.

DOI:10.7705/biomedica.7120
PMID:39088531
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11326222/
Abstract

Mucormycosis is a rare fungal infection caused by fungi of the Mucorales order that occurs in immunocompromised individuals or with loss of skin or mucosa barrier integrity. This report presents four cases of rhinocerebral mucormycosis attended at a third-level hospital in Cali (Colombia) during a period of three years. All patients had different case histories and times of evolution. All four had a previous or de novo diagnosis of type 2 diabetes mellitus, with glycated hemoglobin higher than 10% on admission. We ruled out other possible pathologies that could explain their immunocompromised condition. Mucormycosis diagnosis was made with direct visualization of hyaline coenocytic hyphae on biopsies. The basis of treatment was liposomal amphotericin B and surgical debridement. Two patients presented bacterial coinfection. One asked for voluntary discharge without having completed the treatment, and another one died. The remaining two have attended controls and had an adequate evolution.

摘要

毛霉病是一种由毛霉目真菌引起的罕见真菌感染,发生于免疫功能低下的个体或皮肤或粘膜屏障完整性受损的情况下。本报告介绍了在三年期间于卡利(哥伦比亚)一家三级医院就诊的4例鼻脑型毛霉病病例。所有患者都有不同的病史和病程。4例患者均有2型糖尿病既往诊断或新发诊断,入院时糖化血红蛋白高于10%。我们排除了其他可能解释其免疫功能低下状况的病理情况。通过活检直接观察到透明的多核菌丝,从而做出毛霉病诊断。治疗的基础是脂质体两性霉素B和手术清创。2例患者出现细菌合并感染。1例患者未完成治疗要求自动出院,另1例死亡。其余2例患者接受了随访,病情进展良好。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d342/11326222/7214bbe78b1a/2590-7379-bio-44-02-7120-gf5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d342/11326222/f534f7c59273/2590-7379-bio-44-02-7120-gf1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d342/11326222/eb6768c45cc5/2590-7379-bio-44-02-7120-gf2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d342/11326222/1f71e2078180/2590-7379-bio-44-02-7120-gf3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d342/11326222/9d01c9440936/2590-7379-bio-44-02-7120-gf4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d342/11326222/7214bbe78b1a/2590-7379-bio-44-02-7120-gf5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d342/11326222/f534f7c59273/2590-7379-bio-44-02-7120-gf1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d342/11326222/eb6768c45cc5/2590-7379-bio-44-02-7120-gf2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d342/11326222/1f71e2078180/2590-7379-bio-44-02-7120-gf3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d342/11326222/9d01c9440936/2590-7379-bio-44-02-7120-gf4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d342/11326222/7214bbe78b1a/2590-7379-bio-44-02-7120-gf5.jpg

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本文引用的文献

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Mini Review: Risk Assessment, Clinical Manifestation, Prediction, and Prognosis of Mucormycosis: Implications for Pathogen- and Human-Derived Biomarkers.迷你综述:毛霉病的风险评估、临床表现、预测及预后:对病原体和人类来源生物标志物的启示
Front Microbiol. 2022 Jun 20;13:895989. doi: 10.3389/fmicb.2022.895989. eCollection 2022.
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Global guideline for the diagnosis and management of mucormycosis: an initiative of the European Confederation of Medical Mycology in cooperation with the Mycoses Study Group Education and Research Consortium.全球毛霉病诊断和管理指南:欧洲医学真菌学会联合会与真菌感染研究组教育和研究联盟合作开展的一项倡议。
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Type 2 Diabetes and its Impact on the Immune System.2型糖尿病及其对免疫系统的影响。
Curr Diabetes Rev. 2020;16(5):442-449. doi: 10.2174/1573399815666191024085838.
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Mucormycosis in South America: A review of 143 reported cases.南美洲毛霉病:143 例报告病例的回顾。
Mycoses. 2019 Sep;62(9):730-738. doi: 10.1111/myc.12958. Epub 2019 Jul 11.
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Global Epidemiology of Mucormycosis.毛霉病的全球流行病学
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[Rhino-orbito-cerebral mucormycosis from dental origin: Case report].[源自牙科的鼻眶脑毛霉菌病:病例报告]
Biomedica. 2018 Mar 15;38(1):27-31. doi: 10.7705/biomedica.v38i0.3383.
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Mucormycoses.毛霉病
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Mucormycosis--from the pathogens to the disease.毛霉菌病——从病原体到疾病。
Clin Microbiol Infect. 2014 Jun;20 Suppl 6:60-6. doi: 10.1111/1469-0691.12566. Epub 2014 Feb 24.
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Diabetes and mucormycosis: a complex interplay.糖尿病与毛霉菌病:复杂的相互作用。
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