Tedder M, Spratt J A, Anstadt M P, Hegde S S, Tedder S D, Lowe J E
Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710.
Ann Thorac Surg. 1994 Apr;57(4):1044-50. doi: 10.1016/0003-4975(94)90243-7.
Mucormycosis is an opportunistic fungal infection that commonly begins by invading the respiratory tract. The purpose of the present study was to define the clinical presentation of pulmonary mucormycosis and to evaluate current treatment regimens. Thirty patients treated at our institution and 225 cases reported in the literature were reviewed. For the combined groups, the mean age at presentation was 41 +/- 21 years and associated medical conditions included leukemia or lymphoma (37%), diabetes mellitus (32%), chronic renal failure (18%), history of organ transplantation (7.6%), or a known solid tumor (5.6%). The in-hospital mortality was 65% for patients with isolated pulmonary mucormycosis, 96% for those with disseminated disease, and 80% overall. The mortality in patients treated surgically was 11%, significantly lower than the 68% mortality in those treated medically (p = 0.0004). The most common causes of death were fungal sepsis (42%), respiratory insufficiency (27%), and hemoptysis (13%). Pulmonary mucormycosis has a high mortality; however, antifungal agents appear to improve survival. In addition, surgical resection may provide additional benefit to patients with pulmonary mucormycosis confined to one lung.
毛霉病是一种机会性真菌感染，通常始于呼吸道感染。本研究的目的是明确肺毛霉病的临床表现并评估当前的治疗方案。我们回顾了在本机构接受治疗的30例患者以及文献报道的225例病例。对于合并组，发病时的平均年龄为41±21岁，相关的基础疾病包括白血病或淋巴瘤（37%）、糖尿病（32%）、慢性肾衰竭（18%）、器官移植史（7.6%）或已知实体瘤（5.6%）。孤立性肺毛霉病患者的院内死亡率为65%，播散性疾病患者为96%，总体死亡率为80%。手术治疗患者的死亡率为11%，显著低于药物治疗患者的68%（p = 0.0004）。最常见的死亡原因是真菌败血症（42%）、呼吸功能不全（27%）和咯血（13%）。肺毛霉病死亡率很高；然而，抗真菌药物似乎可提高生存率。此外，手术切除可能会给局限于一侧肺的肺毛霉病患者带来额外益处。
