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有或无眼眶内容剜除术的鼻眶毛霉菌病的治疗及生存结果:一项回顾性病例系列研究及文献综述

Treatment and Survival Outcomes in Rhino-Orbital Mucormycosis with and without Orbital Exenteration: A Retrospective Case Series and Literature Review.

作者信息

Boqaaiya Shadi, Cohen Yuval, Beiruti Wiegler Karine, Chassid Otzem

机构信息

Ziv Medical Center, Department of Ophthalmology, Safed, 1311001, Israel.

Azrieli Faculty of Medicine, Bar-Ilan University, Safed, 1311502, Israel.

出版信息

Int Med Case Rep J. 2025 Jun 24;18:747-762. doi: 10.2147/IMCRJ.S530233. eCollection 2025.

DOI:10.2147/IMCRJ.S530233
PMID:40585964
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12205758/
Abstract

Rhino-orbital mucormycosis (ROM) is a life-threatening, fungal infection, primarily affecting immunocompromised patients. The role of orbital exenteration in treatment remains debated, especially regarding its impact on survival outcomes. This case series presents two patients from our Ophthalmology department and compares them with eight cases from the literature, focusing on treatment outcomes and survival rates. We specifically explore the impact of orbital exenteration and other management strategies. The analysis reveals that survival outcomes are closely linked to the timely initiation of antifungal therapy, the patient's underlying conditions, and the extent of orbital involvement at the time of diagnosis. Our findings, in line with the literature, show that early-stage ROM can be treated successfully with less invasive methods, while advanced cases may require orbital exenteration. The need for exenteration should be evaluated on a case-by-case basis, with early detection and appropriate antifungal treatment being critical factors for survival. This study highlights the importance of early diagnosis and individualized treatment plans, emphasizing that while orbital exenteration may improve survival in severe cases, less invasive interventions should be considered for less advanced ROM. Further research and standardized guidelines are needed to refine treatment strategies.

摘要

鼻眶毛霉菌病(ROM)是一种危及生命的真菌感染,主要影响免疫功能低下的患者。眶内容剜除术在治疗中的作用仍存在争议,尤其是其对生存结局的影响。本病例系列展示了我们眼科的两名患者,并将他们与文献中的八例病例进行比较,重点关注治疗结果和生存率。我们特别探讨了眶内容剜除术及其他治疗策略的影响。分析表明,生存结局与抗真菌治疗的及时启动、患者的基础状况以及诊断时眼眶受累的程度密切相关。我们的研究结果与文献一致,表明早期ROM可以通过侵入性较小的方法成功治疗,而晚期病例可能需要进行眶内容剜除术。是否需要进行眶内容剜除术应逐案评估,早期检测和适当的抗真菌治疗是生存的关键因素。本研究强调了早期诊断和个体化治疗方案的重要性,强调虽然眶内容剜除术可能会提高重症病例的生存率,但对于病情较轻的ROM应考虑采用侵入性较小的干预措施。需要进一步的研究和标准化指南来完善治疗策略。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5bc6/12205758/3a3b4edcef5c/IMCRJ-18-747-g0005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5bc6/12205758/c37fdf0b75c7/IMCRJ-18-747-g0001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5bc6/12205758/ff961a062a77/IMCRJ-18-747-g0002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5bc6/12205758/5d11ad782725/IMCRJ-18-747-g0003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5bc6/12205758/07b614c3e0a7/IMCRJ-18-747-g0004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5bc6/12205758/3a3b4edcef5c/IMCRJ-18-747-g0005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5bc6/12205758/c37fdf0b75c7/IMCRJ-18-747-g0001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5bc6/12205758/ff961a062a77/IMCRJ-18-747-g0002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5bc6/12205758/5d11ad782725/IMCRJ-18-747-g0003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5bc6/12205758/07b614c3e0a7/IMCRJ-18-747-g0004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5bc6/12205758/3a3b4edcef5c/IMCRJ-18-747-g0005.jpg

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Rhino-orbital-cerebral mucormycosis in acute myeloid leukemia patients: a case series from Sri Lanka.急性髓系白血病患者的鼻眶脑毛霉菌病:来自斯里兰卡的病例系列
BMC Infect Dis. 2024 Dec 26;24(1):1465. doi: 10.1186/s12879-024-10334-y.
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Rhino-Orbital Mucormycosis Presenting As Orbital Apex Syndrome With Central Retinal Artery Occlusion: A Rare Phenomenon.
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Cureus. 2024 Nov 10;16(11):e73400. doi: 10.7759/cureus.73400. eCollection 2024 Nov.
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A rare presentation of rhino-orbital-cutaneous mucormycosis in an immunocompetent patient: a case report.免疫功能正常患者罕见的鼻眶皮脑毛霉病表现:一例病例报告。
Pan Afr Med J. 2024 May 15;48:13. doi: 10.11604/pamj.2024.48.13.43454. eCollection 2024.
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