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免疫功能正常宿主的腹腔毛霉菌病:一种罕见表现及文献综述

Intra-abdominal Mucormycosis in an Immunocompetent Host: A Rare Presentation and Literature Review.

作者信息

Hamamah Sevag, Savalia Nupur, Hai Faizi

机构信息

Internal Medicine, Scripps Mercy Hospital, San Diego, USA.

Gastroenterology, Scripps Mercy Hospital, San Diego, USA.

出版信息

Cureus. 2025 Mar 17;17(3):e80730. doi: 10.7759/cureus.80730. eCollection 2025 Mar.

DOI:10.7759/cureus.80730
PMID:40103914
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11913594/
Abstract

Mucormycosis is a severe, opportunistic infection caused by a taxonomical group of thermotolerant fungi primarily affecting the immunocompromised. Intra-abdominal involvement in mucormycosis is a rare entity, particularly in immunocompetent individuals. We present a fatal case of gallbladder and renal mucormycosis in an immunocompetent female, leading to septic shock and death. The diagnosis was confirmed via histopathology following cholecystectomy for suspected gangrenous cholecystitis and open right nephrectomy due to kidney infarction. Quantitative polymerase chain reaction of the tissue identified the presence of  The clinical picture was confounded by ongoing sepsis due to a -infected retroperitoneal hematoma non-specific imaging findings, and the absence of traditional risk factors for mucormycosis, leading to a delayed diagnosis. Despite surgical debridement, initiation of liposomal amphotericin B with posaconazole, and aggressive treatment in the intensive care unit, the patient succumbed to complications of mucormycosis. Despite adequate antibiotic coverage, this case underscores the importance of considering Mucorales infection in otherwise immunocompetent patients with a deteriorating clinical condition. Early diagnosis and appropriate intervention are essential in enhancing mucormycosis survivability, though mortality rates remain high in severe cases.

摘要

毛霉病是一种由一组耐热真菌引起的严重机会性感染,主要影响免疫功能低下者。毛霉病累及腹腔是一种罕见情况,在免疫功能正常个体中尤为罕见。我们报告一例免疫功能正常女性发生胆囊和肾脏毛霉病的致死病例,最终导致感染性休克和死亡。在因疑似坏疽性胆囊炎行胆囊切除术以及因肾梗死行右侧开放性肾切除术后,通过组织病理学确诊了该病例。组织的定量聚合酶链反应确定存在 临床情况因感染性腹膜后血肿导致的持续脓毒症、非特异性影像学表现以及缺乏毛霉病的传统危险因素而变得复杂,导致诊断延迟。尽管进行了手术清创、启动了脂质体两性霉素B联合泊沙康唑治疗以及在重症监护病房进行了积极治疗,但患者仍死于毛霉病并发症。尽管给予了充分的抗生素覆盖,但该病例强调了在临床状况恶化的免疫功能正常患者中考虑毛霉目感染的重要性。早期诊断和适当干预对于提高毛霉病的生存率至关重要,尽管严重病例的死亡率仍然很高。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ac91/11913594/2f0b14576677/cureus-0017-00000080730-i06.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ac91/11913594/0032accb5055/cureus-0017-00000080730-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ac91/11913594/8e542023c14f/cureus-0017-00000080730-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ac91/11913594/68ce7ba94d42/cureus-0017-00000080730-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ac91/11913594/61a9d6b0b11d/cureus-0017-00000080730-i04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ac91/11913594/7bd9967e51eb/cureus-0017-00000080730-i05.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ac91/11913594/2f0b14576677/cureus-0017-00000080730-i06.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ac91/11913594/0032accb5055/cureus-0017-00000080730-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ac91/11913594/8e542023c14f/cureus-0017-00000080730-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ac91/11913594/68ce7ba94d42/cureus-0017-00000080730-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ac91/11913594/61a9d6b0b11d/cureus-0017-00000080730-i04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ac91/11913594/7bd9967e51eb/cureus-0017-00000080730-i05.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ac91/11913594/2f0b14576677/cureus-0017-00000080730-i06.jpg

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本文引用的文献

1
Interlaboratory assays from the fungal PCR Initiative and the Modimucor Study Group to improve qPCR detection of Mucorales DNA in serum: one more step toward standardization.真菌PCR计划和毛霉样真菌研究小组开展的实验室间分析,旨在改进血清中毛霉目DNA的定量PCR检测:向标准化又迈进了一步。
J Clin Microbiol. 2025 Feb 19;63(2):e0152524. doi: 10.1128/jcm.01525-24. Epub 2024 Dec 31.
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Mucormycosis.毛霉病
Infect Dis Clin North Am. 2025 Mar;39(1):121-144. doi: 10.1016/j.idc.2024.11.008. Epub 2024 Dec 4.
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Recent Advances in Diagnostic Approaches for Mucormycosis.
毛霉菌病诊断方法的最新进展
J Fungi (Basel). 2024 Oct 19;10(10):727. doi: 10.3390/jof10100727.
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Diverse Clinical Manifestations and Challenges of Mucormycosis: Insights From Serial Cases.毛霉病的多样临床表现及挑战:系列病例分析
Open Forum Infect Dis. 2023 Oct 24;10(11):ofad527. doi: 10.1093/ofid/ofad527. eCollection 2023 Nov.
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Fungal infections in immunocompromised critically ill patients.免疫功能低下的重症患者的真菌感染
J Intensive Med. 2024 Mar 16;4(3):299-306. doi: 10.1016/j.jointm.2024.01.005. eCollection 2024 Jul.
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Early diagnosis and aggressive surgical resection matters to cure rhinocerebral mucormycosis: Six case reports.早期诊断和积极的手术切除对治愈鼻-脑毛霉菌病至关重要:六例报告。
J Stomatol Oral Maxillofac Surg. 2024 Oct;125(5S2):101898. doi: 10.1016/j.jormas.2024.101898. Epub 2024 May 1.
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Diagnosis of Mucormycosis Using Frozen Section, Histopathology, Culture, and Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) Techniques: A Comparative Study.使用冰冻切片、组织病理学、培养及逆转录聚合酶链反应(RT-PCR)技术诊断毛霉菌病:一项对比研究
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Influence of Bariatric Surgery on Gut Microbiota Composition and Its Implication on Brain and Peripheral Targets.减重手术对肠道微生物组成的影响及其对脑和外周靶标的影响。
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A Systematic Review of the Therapeutic Outcome of Mucormycosis.毛霉菌病治疗结果的系统评价
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