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鼻-鼻窦毛霉菌病肺部受累激增的近期趋势:病例系列:鼻-鼻窦毛霉菌病的肺部受累情况

Recent Trend of Surge in Pulmonary involvement in Sinonasal Mucormycosis: A Case Series: Pulmonary involvement in Sinonasal Mucormycosis.

作者信息

Negi Tashi, Rajan Nikhil, Saini Vaibhav, Gupta Vikasdeep, Mohan Ankur, Rana Manjit Kaur, Krishnamoorthi Sivanantham

机构信息

Department of Otorhinolaryngology, AIIMS Bathinda, Flat No. 2026, 6th Floor, Tower 1, Type 2 Apartments, Dabwali Road, Bathinda, Punjab 151005 India.

Department of Pathology, AIIMS Bathinda, Bathinda, India.

出版信息

Indian J Otolaryngol Head Neck Surg. 2025 Jul;77(7):2636-2643. doi: 10.1007/s12070-025-05523-3. Epub 2025 May 16.

Abstract

Mucormycosis is an angio-invasive fungal infection affecting individuals with immuno-compromised state. The case series is a retrospective analysis of patients in a single centre and highlights the surge of pulmonary involvement in patients with sinonasal mucormycosis. To determine incidence of sequential pulmonary involvement in diagnosed cases of sino-nasal mucormycosis undergoing treatment in a tertiary health care facility and devise institutional algorithm for management. Records of patients diagnosed with sino-nasal mucormycosis who underwent treatment in tertiary care health facility from January 2023 to January 2025 were reviewed in view of simultaneous pulmonary involvement. We found four patients during the time duration of two years with simultaneous sino-nasal and pulmonary mucormycosis. Diabetes mellitus was most common predisposing factor in all patients with mean glycosylated haemoglobin of 10.9%. Sputum microscopy for KOH mount was negative in all four patients. One of the patients underwent computed tomography guided biopsy from right lung lesion after the onset of pulmonary symptoms. Histo-morphological features were consistent with clinical diagnosis of mucormycosis. Detection of simultaneous pulmonary involvement in sino-nasal mucormycosis is an arduous task. Timely detection of non-specific symptoms of pulmonary involvement is responsible for favourable prognosis. However, diagnosing pulmonary mucormycosis can be challenging due to low threshold to perform invasive diagnostic procedures, the limited sensitivity of sputum microscopy, and presence of non-specific symptoms.

摘要

毛霉病是一种侵袭血管的真菌感染,影响免疫功能低下的个体。该病例系列是对单一中心患者的回顾性分析,突出了鼻-鼻窦毛霉病患者肺部受累情况的激增。目的是确定在三级医疗保健机构接受治疗的确诊鼻-鼻窦毛霉病病例中继发性肺部受累的发生率,并制定机构管理算法。鉴于同时存在肺部受累情况,对2023年1月至2025年1月在三级医疗保健机构接受治疗的确诊鼻-鼻窦毛霉病患者的记录进行了回顾。我们在两年时间内发现了4例同时患有鼻-鼻窦和肺部毛霉病的患者。糖尿病是所有患者中最常见的易感因素,平均糖化血红蛋白为10.9%。所有4例患者的痰氢氧化钾涂片显微镜检查均为阴性。其中1例患者在出现肺部症状后接受了计算机断层扫描引导下的右肺病变活检。组织形态学特征与毛霉病的临床诊断一致。检测鼻-鼻窦毛霉病患者同时存在的肺部受累情况是一项艰巨的任务。及时发现肺部受累的非特异性症状有助于获得良好预后。然而,由于进行侵入性诊断程序的阈值较低、痰显微镜检查的敏感性有限以及存在非特异性症状,诊断肺部毛霉病可能具有挑战性。

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本文引用的文献

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Epidemiology of Mucormycosis in India.印度毛霉菌病的流行病学
Microorganisms. 2021 Mar 4;9(3):523. doi: 10.3390/microorganisms9030523.
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J Fungi (Basel). 2019 Mar 14;5(1):23. doi: 10.3390/jof5010023.
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Pulmonary mucormycosis: A case report and review of the literature.肺毛霉病:一例病例报告及文献综述
Oncol Lett. 2016 May;11(5):3049-3053. doi: 10.3892/ol.2016.4370. Epub 2016 Mar 22.

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