Adam R D, Hunter G, DiTomasso J, Comerci G
Department of Medicine, University of Arizona College of Medicine, Tucson 85724.
Clin Infect Dis. 1994 Jul;19(1):67-76. doi: 10.1093/clinids/19.1.67.
Twenty-five patients with mucormycosis were seen at two university-affiliated hospitals from 1979 to 1993. These cases included 10 cutaneous, 9 rhinocerebral, and 3 disseminated infections, as well as one case each of pulmonary, renal, and peritoneal dialysis catheter-related infection. Eleven of the patients were diabetic and seven had ketoacidosis, including four who became acidotic after admission to the hospital. The mortality rates associated with rhinocerebral, disseminated, and pulmonary infections were 78%-100%, while those associated with cutaneous and miscellaneous forms were zero. In view of the prominence of cutaneous infections, the 10 cases of cutaneous mucormycosis (in addition to a case from a community hospital) are reported in detail. Systemic diseases were present in four of the 11 patients. Local factors leading to infection were identified in nine of the cases and included motor vehicle accident-related and other trauma, surgery, a spider bite, and an intravenous infusion catheter. The cases of cutaneous mucormycosis reported in the literature have been analyzed for identification of predisposing factors, treatment, and outcome. Aggressive surgical debridement is the most important component of therapy, and administration of amphotericin B is a useful adjunct. Skin grafting is useful as a method of repairing defects left by extensive debridement.
1979年至1993年期间，两所大学附属医院共收治了25例毛霉菌病患者。这些病例包括10例皮肤感染、9例鼻脑感染、3例播散性感染，以及1例肺部感染、1例肾脏感染和1例腹膜透析导管相关感染。其中11例患者患有糖尿病，7例发生了酮症酸中毒，包括4例入院后发生酸中毒的患者。鼻脑感染、播散性感染和肺部感染的死亡率为78%-100%，而皮肤感染和其他类型感染的死亡率为零。鉴于皮肤感染较为突出，现将10例皮肤毛霉菌病病例（外加1例来自社区医院的病例）详细报告。11例患者中有4例存在全身性疾病。9例病例中发现了导致感染的局部因素，包括机动车事故相关及其他创伤、手术、蜘蛛咬伤和静脉输液导管。对文献中报道的皮肤毛霉菌病病例进行了分析，以确定易感因素、治疗方法和治疗结果。积极的手术清创是治疗的最重要组成部分，两性霉素B的应用是一种有效的辅助治疗方法。皮肤移植作为修复广泛清创后留下的缺损的一种方法很有用。
