毛霉菌病的流行病学、临床表现、治疗及转归：法国单中心77例病例回顾

Epidemiology, Clinical Manifestations, Treatment, and Outcome of Mucormycosis: A Review of 77 Cases From a Single Center in France.

作者信息

Denis Blandine, Resche-Rigon Matthieu, Raffoux Emmanuel, Ronchetti Anne-Marie, Dudoignon Emmanuel, Verillaud Benjamin, Valade Sandrine, Lorillon Gwenaël, Rabian Florence, Xhaard Aliénor, Touratier Sophie, Hamane Samia, Alanio Alexandre, De Castro Nathalie

机构信息

Department of Infectious Diseases, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France.

Department of Biomedical Statistics and Methodology, Hôpital Saint-Louis, Fernand Widal, Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France.

出版信息

Open Forum Infect Dis. 2024 Jul 23;11(8):ofae426. doi: 10.1093/ofid/ofae426. eCollection 2024 Aug.

DOI:10.1093/ofid/ofae426

PMID:39183813

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11342388/

Abstract

BACKGROUND

The aim of this study was to assess the epidemiology, clinical manifestations, and outcome of mucormycosis over 15 years in a single center in France.

METHODS

We conducted a retrospective analysis of all mucormycosis cases in our institution from 1 January 2006 to 31 December 2020 and analyzed patients' medical records, laboratory results, and treatment to describe the epidemiology, clinical manifestations, diagnosis, treatment, and outcome. Mucorales quantitative polymerase chain reaction (qPCR) for the diagnosis was implemented in 2015.

RESULTS

Seventy-seven mucormycosis cases were analyzed in 77 patients, with a median age of 54 years (60% male). Identified risk factors were hematological diseases (46 cases [60%]), solid malignancies (2 cases), solid organ transplants (3), burns (18), diabetes only (7), and trauma (1). Sites of infection were lungs (42%), sinus (36%), skin (31%), central nervous system (9%), liver (8%), others (6%), and disseminated (12%). Diagnosis remained difficult and qPCR contributed to mucormycosis diagnosis in 30% of cases. Among hematology patients, serum qPCR was the only positive test in 15% of cases. A mixed mold infection was diagnosed in 24 of 77 (31%) patients. Surgical treatment was undertaken in 43 (56%) cases. Most patients received liposomal amphotericin B (89%), with a combination therapy in 18 of 77 cases (23%). Three-month survival rate was 40% (95% confidence interval [CI], .30-.53]). As for treatment, adjunction of surgery (hazard ratio, 0.47 [95%CI, .25-.91); = 0.02) was associated with lower mortality.

CONCLUSIONS

Mucormycosis remained associated with high mortality, especially in the hematological and burn populations. Surgery in combination with antifungal treatment was associated with improved survival.

摘要

背景

本研究旨在评估法国某单一中心15年间毛霉菌病的流行病学、临床表现及转归。

方法

我们对2006年1月1日至2020年12月31日在我院确诊的所有毛霉菌病病例进行回顾性分析，分析患者的病历、实验室检查结果及治疗情况，以描述其流行病学、临床表现、诊断、治疗及转归。2015年开始采用毛霉目定量聚合酶链反应（qPCR）进行诊断。

结果

分析了77例患者的77例毛霉菌病病例，中位年龄54岁（男性占60%）。已确定的危险因素包括血液系统疾病（46例[60%]）、实体恶性肿瘤（2例）、实体器官移植（3例）、烧伤（18例）、单纯糖尿病（7例）及创伤（1例）。感染部位包括肺部（42%）、鼻窦（36%）、皮肤（31%）、中枢神经系统（9%）、肝脏（8%）、其他（6%）及播散性感染（12%）。诊断仍较困难，qPCR在30%的病例中有助于毛霉菌病的诊断。在血液系统疾病患者中，血清qPCR是15%病例中唯一的阳性检查。77例患者中有24例（31%）诊断为混合霉菌感染。43例（56%）患者接受了手术治疗。大多数患者接受了脂质体两性霉素B治疗（89%），77例中有18例（23%）接受了联合治疗。3个月生存率为40%（95%置信区间[CI]，0.30 - 0.53）。至于治疗，手术辅助治疗（风险比，0.47[95%CI，0.25 - 0.91]；P = 0.02）与较低的死亡率相关。