不规则毛霉感染引起的皮肤毛霉病20例回顾性分析

目的通过对不规则毛霉感染病例的回顾性分析,探讨不规则毛霉感染引起皮肤毛霉病的流行病学、易感因素、临床表现、诊断方法及治疗策略,提高临床医生的警惕性及诊治经验。方法对检索到的20例不规则毛霉感染病例资料进行总结、分析。结果 20例不规则毛霉感染患者均表现为皮肤毛霉病,仅1例同时伴有肺部感染。15例来自中国,1例有糖尿病史,1例有白血病史,10例有外伤、手术或叮咬史。皮损几乎均出现在暴露部位,其中鼻面部13例,四肢7例,病程多呈慢性。早期表现为红斑、丘疹、结节,后期可发展成溃疡、坏死、黑痂及骨质破坏。经真菌镜检、培养、组织病理、ITS区测序等检查证实为不规则毛霉。两性霉素B及其脂质体单独或联合伊曲康唑治疗预后好。结论不规则毛霉感染多发生于免疫正常者,外伤、烧伤、手术及叮咬是最主要诱发因素。感染主要累及鼻面部及四肢皮肤暴露部位,以红斑、坏死为主要表现,极少累及内脏。真菌培养及组织病理检查可以诊断该病,ITS区测序可明确鉴定到种。及早诊断并给予清创及两性霉素B是治疗成功的关键。

Mucormycosis caused byMucor irregularis,a retrospective review of 20 cases

ObjectiveTo investigate and discuss the epidemiology, risk factors, clinical manifestations, diagnostic methods and treatment strategies forMucor irregularis infection. To improve the experience of diagnosis and treatment of mucormycosis. MethodsTwenty cases of mucormycosis caused byMucor irregularis from our case and reported literature were retrospectively summarized and analyzed.ResultsOf the 20 cases, 15 cases were found in China and all were cutaneous mucormycosis, except for one case, which was accompanied with pulmonary infection. Two patients had history of diabetes and acute myeloblastic leukemia （AML） respectively, while other ten patients had injuries, surgery or bite history. The lesions were mostly located in the exposed area, including nose, face （13 out of 20）, and extremities （7 out of 17）, which were presented as erythema, ulcer, necrosis, dark scabs and destruction of bone. The diagnosis was conifrmed asMucor irregularis infection by fungal examination, histopathology and DNA sequencing.Either Amphotericin B deoxycholate or liposome alone or combining with itraconazole for treatment presented a good recovery.ConclusionsPatients with mucormycosis caused byMucor irregularis did not display apparent immunodeficiency. Injuries, burns, surgeries and bite are key risk factors. Mucormycosis caused byMucor irregularis often located in the nasal and facial areas and limbs, rarely involving the internal organ. Fungal culture and histopathological examination can diagnose the disease, species can be identiifed by DNA sequencing （ITS region）. After early diagnosis and treatment with surgical debridement and amphotericin B, the prognosis of the patients are favorable.