Weprin B E, Hall W A, Goodman J, Adams G L
Department of Neurosurgery, University of Minnesota Hospital and Clinic, Minneapolis 55455, USA.
J Neurosurg. 1998 Mar;88(3):570-5. doi: 10.3171/jns.1998.88.3.0570.
Mucormycosis refers to a group of rapidly progressive infections caused by fungi belonging to the order Mucorales. Infection most often develops in individuals with immunological or metabolic compromise, although patients without underlying abnormalities have been affected. Specific clinical manifestations are associated with various predisposing factors. Rhinocerebral mucormycosis is the most common form and most frequently develops in individuals with poorly controlled diabetes mellitus. The extent of anatomical involvement and clinical course are unpredictable, depending on the intrinsic factors of the host. Over the past 20 years the prognosis for patients with rhinocerebral mucormycosis, once considered to be a uniformly fatal disease, has improved. Coordinated medical and surgical treatment, including rapid diagnosis, the advent of systemic antifungal agents, aggressive surgical debridement, and control of the underlying disease process, have been credited with its successful management. The range of survival rates recorded with the regimen of combined therapies is wide because the number of patients reported is limited and anatomical involvement is diverse. Survival with intracerebral abscess is rare. The authors describe the successful management of a patient who developed a bifrontal fungal abscess during treatment for rhinocerebral mucormycosis associated with ketoacidosis and diabetes mellitus. The patient remains without radiographic or clinical evidence of infection more than 2 years after treatment. The authors review the characteristic clinical, radiographic, and pathological features of previously reported infections and emphasize the importance of early detection and aggressive treatment in the management of this frequently fulminant and fatal disease.
毛霉病是指由毛霉目真菌引起的一组快速进展性感染。感染最常发生在免疫或代谢功能受损的个体中，不过也有未患基础疾病的患者受到影响。特定的临床表现与各种易感因素相关。鼻脑型毛霉病是最常见的类型，最常发生在糖尿病控制不佳的个体中。解剖学受累范围和临床病程难以预测，取决于宿主的内在因素。在过去20年里，曾经被认为是一种必死无疑的疾病——鼻脑型毛霉病患者的预后有所改善。协调的药物和手术治疗，包括快速诊断、全身性抗真菌药物的出现、积极的手术清创以及对基础疾病进程的控制，被认为是其成功治疗的原因。联合治疗方案记录的生存率范围很广，因为报告的患者数量有限且解剖学受累情况多样。脑内脓肿患者存活的情况很罕见。作者描述了一名在治疗与酮症酸中毒和糖尿病相关的鼻脑型毛霉病期间发生双侧额叶真菌性脓肿的患者的成功治疗情况。该患者在治疗后2年多没有感染的影像学或临床证据。作者回顾了先前报道的感染的特征性临床、影像学和病理学特征，并强调了早期检测和积极治疗在管理这种经常暴发性和致命性疾病中的重要性。
