烧伤患者毛霉菌侵袭性感染（附4例报告）并文献复习

目的探讨烧伤患者毛霉菌侵袭性感染的临床表现、诊断和治疗方法。方法分析我科多年来收治的4例毛霉菌感染病例。本组4例均为男性,烧伤面积70%~94%,分别于伤后18~31d发生毛霉菌感染,4例均采用组织病理切片,2例同时有创面培养毛霉菌感染确诊。确诊后予彻底清创或截肢,并调整抗真菌药物。结果本组4例均于病程中后期出现毛霉菌感染,均有成片肌肉受累,在清创（其中截肢3例）、抗真菌治疗后,4例均于短期内死亡。结论烧伤创面发生毛霉菌侵袭性感染十分少见,病情进展快,预后差;尽早手术切痂植皮、封闭创面,去除毛霉菌定植的土壤;对可疑病例应及时确诊,立即手术彻底清创或截肢、使用两性霉素B或其脂质体有助于改善预后。

Invasive mucormycosis in burns: report of four cases and literature review

Objective To describe the characteristics of invasive mucormycosis in burn patients and to evaluate the diagnosis and treatment of the disease. Methods Four extensive burn patients were enrolled in the study. All the patients were male and the total burn surface area was from 70% to 94%. Mucormycosis took place from 18th to 31st day postburn. They were all diagnosed by histopathology and two of them had the evidences of wounds culture. Emergent debridements or amputation were performed after diagnosis, and antifungal agents were used. Results The infection of Mucor took place on the late course in all the 4 patients, and massive necrotic darken muscles could be observed in all the cases. After debridements, including amputation in 3 cases and antifungal therapy, all of them died shortly after diagnosis were made. Conclusions Invasive mucormycosis in burn patients is rare. It is progressing rapidly with an unfavorable prognosis. It is helpful to get better prognosis by performing escharotomy and cover the burn wounds early so as to remove the soil for cloning of zygomycetes. For suspected cases, emergent debridements or amputation should be performed soon after diagnosis has been made, and amphotericin B or amphotericin B liposome is the first choice of the antifungal agents