CAJ | 학술논문

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。
목적：통과대불규칙모매감염병례적회고성분석，탐토불규칙모매감염인기피부모매병적류행병학、역감인소、림상표현、진단방법급치료책략，제고림상의생적경척성급진치경험。방법대검색도적20례불규칙모매감염병례자료진행총결、분석。결과20례불규칙모매감염환자균표현위피부모매병，부1례동시반유폐부감염。15례래자중국，1례유당뇨병사，1례유백혈병사，10례유외상、수술혹정교사。피손궤호균출현재폭로부위，기중비면부13례，사지7례，병정다정만성。조기표현위홍반、구진、결절，후기가발전성궤양、배사、흑가급골질파배。경진균경검、배양、조직병리、ITS구측서등검사증실위불규칙모매。량성매소B급기지질체단독혹연합이곡강서치료예후호。결론불규칙모매감염다발생우면역정상자，외상、소상、수술급정교시최주요유발인소。감염주요루급비면부급사지피부폭로부위，이홍반、배사위주요표현，겁소루급내장。진균배양급조직병리검사가이진단해병， ITS구측서가명학감정도충。급조진단병급여청창급량성매소B시치료성공적관건。
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.