毛霉菌病 - 维基百科,自由的百科全书

毛霉菌病
又称接合菌病(Zygomycosis)[1]
眼窩周圍被毛霉菌感染的病患
病因免疫缺乏
风险因素愛滋病糖尿病淋巴瘤器官移植接受者、長期類固醇使用者
治療兩性黴素B外科清創
预后不良[2]
分类和外部资源
醫學專科傳染病學
ICD-111F2C
ICD-10B46.0、​B46.5
DiseasesDB31759
MedlinePlus000649
Orphanet73263
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毛霉菌病(英語:Mucormycosis),部分媒體稱之為黑真菌症(black fungus)[3],是毛霉門真菌感染造成的疾病[4],其中以毛黴屬根黴屬犁头霉属小克銀漢黴屬真菌的感染為大宗[5][6]。此感染過去稱為接合菌病(Zygomycosis),但接合菌門的分類因爲複系群而已不再使用,且接合菌門除毛霉外還有些蟲黴目蛙糞霉耳霉)的真菌也可感染人類,現多以毛霉菌病、耳霉病英语conidiobolomycosis[7]蛙粪霉病[8]等具體病名稱呼。

症狀

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一名感染毛霉菌病的男子臉部出現紅腫的病徵,右方為其皮膚樣本在電子顯微鏡下發現毛霉菌的孢子囊[9]

毛霉菌多感染鼻竇腦部肺部等部位,還可感染消化道皮膚以及其他器官[10]。病原進入血管後可能導致血栓,造成周圍組織因缺血壞死,若侵染腦部與臉面則會造成單側頭痛、發燒、臉面疼痛、鼻腔阻塞並出現黑色黏液、鼻竇炎以及結膜水腫英语Chemosis等症狀[11]。感染初期被侵染的部位表面外觀正常,隨後迅速轉為紅腫甚至因壞死而呈黑色[12];感染肺部者則會造成呼吸困難、持續咳嗽、咳血腹痛噁心嘔吐等症狀[10]

治療

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愛滋病糖尿病淋巴瘤等癌症、肝硬化腎功能衰竭病患、接受器官移植者以及長期使用皮質類固醇者被毛霉菌感染的風險較高。兩性黴素B為治療此感染的第一線藥物,另外艾沙康唑英语Isavuconazonium也可用於治療此症[13]。藥物治療一段時間後還需開刀移除被感染的組織[10][14],另外高壓氧治療因可能促進嗜中性球的活性而作為此病的輔助療法。此病的癒後情況一般不佳[12]

预后

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本病往往进展迅速,并且对于大约一半的鼻窦型病例、三分之二的肺部型病例和几乎所有广泛型病例致命[15]。皮肤受累的死亡率最低,但也约为15%[16]

流行病學

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毛霉菌的感染相當罕見[10]。2008年美國的一家醫院曾爆發毛霉菌病的院內感染,於2014年才被媒體披露[17][18] 。2011年密蘇里州受喬普林龍捲風英语2011 Joplin tornado侵襲後當地爆發毛霉菌病的疫情,有十數人被感染,其中5人死亡[19]

2020年COVID-19疫情期間,印度多個城市爆發毛霉菌病感染[20],2021年印度各地又爆發數起感染,可能與COVID-19重症病患接受類固醇治療後免疫力降低有關[3]

參考文獻

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  1. ^ RESERVED, INSERM US14-- ALL RIGHTS. Orphanet: Zygomycosis. www.orpha.net. [28 June 2019]. (原始内容存档于2021-05-13). 
  2. ^ Hernández, J. L.; Buckley, C. J. Mucormycosis. January 2021. PMID 31335084. 
  3. ^ 3.0 3.1 Soutik Biswas. Mucormycosis: The 'black fungus' maiming Covid patients in India. BBC. 2021-05-09 [2021-05-11]. (原始内容存档于2021-05-21). 
  4. ^ James, William D.; Berger, Timothy G.; et al. Andrews' Diseases of the Skin: clinical Dermatology. Saunders Elsevier. 2006: 328. ISBN 0-7216-2921-0. 
  5. ^ Rinaldi, Michael G. Zygomycosis. Infectious Disease Clinics of North America. 1989-03-01, 3 (1). ISSN 0891-5520. doi:10.1016/S0891-5520(20)30244-0 (英语). 
  6. ^ Lee, Francis Y. W.; Mossad, Sherif B.; Adal, Karim A. Pulmonary Mucormycosis: The Last 30 Years. Archives of Internal Medicine. 1999-06-28, 159 (12). ISSN 0003-9926. doi:10.1001/archinte.159.12.1301 (英语). 
  7. ^ Sharma, N. L.; Mahajan, V. K.; Singh, P. Orofacial Conidiobolomycosis due to Conidiobolus incongruus. Fallbericht. Orofaziale Conodiobolomykose durch Conidiobolus incongruus. Mycoses. 2003-03-04, 46 (3-4). ISSN 0933-7407. doi:10.1046/j.1439-0507.2003.00851.x (英语). 
  8. ^ van den Berk, Guido EL; Noorduyn, L Arnold; van Ketel, Ruud J; van Leeuwen, Jeannouel; Bemelman, Willem A; Prins, Jan M. A fatal pseudo-tumour: disseminated basidiobolomycosis. BMC Infectious Diseases. 2006-12, 6 (1) [2022-07-28]. ISSN 1471-2334. PMC 1574330可免费查阅. PMID 16978407. doi:10.1186/1471-2334-6-140. (原始内容存档于2022-10-23) (英语). 
  9. ^ Yuping, Ran; Kaiwen, Zhuang; Wenying, Hu; Jinghong, Huang; Xiaowei, Feng; Shuang, Chen; Jiaoqing, Tang; Xiaoxi, Xu; Daoxian, Kang. Observation of Fungi, Bacteria, and Parasites in Clinical Skin Samples Using Scanning Electron Microscopy. Janecek, Milos (编). Modern Electron Microscopy in Physical and Life Sciences. InTech. 2016-02-18. ISBN 978-953-51-2252-4. doi:10.5772/61850 (英语). 
  10. ^ 10.0 10.1 10.2 10.3 Mucormycosis (Zygomycosis): Background, Etiology and Pathophysiology, Epidemiology. 2021-08-23 [2022-07-28]. (原始内容存档于2008-12-02). 
  11. ^ MedlinePlus Medical Encyclopedia: Mucormycosis. [May 19, 2008]. (原始内容存档于2008-05-20). 
  12. ^ 12.0 12.1 Spellberg, Brad; Edwards, John; Ibrahim, Ashraf. Novel Perspectives on Mucormycosis: Pathophysiology, Presentation, and Management. Clinical Microbiology Reviews. 2005-07, 18 (3) [2022-07-28]. ISSN 0893-8512. PMC 1195964可免费查阅. PMID 16020690. doi:10.1128/CMR.18.3.556-569.2005. (原始内容存档于2022-07-28) (英语). 
  13. ^ Lyndsay Mayer. Mucormycosis. Food and Drug Administration. [2017-04-05]. (原始内容存档于2018-01-26). 
  14. ^ Rebecca J. Frey. Mucormycosis. Health A to Z. [May 19, 2008]. (原始内容存档于May 18, 2008). 
  15. ^ Mucormycosis Statistics | Mucormycosis | Fungal Diseases | CDC. www.cdc.gov. 5 May 2020 [25 May 2021]. (原始内容存档于2021-05-21) (美国英语). 
  16. ^ McDonald PJ. Mucormycosis (Zygomycosis): Background, Etiology and Pathophysiology, Epidemiology需要付费订阅. Medscape. 10 September 2018 [2023-04-27]. (原始内容存档于2008-12-02). 
  17. ^ Catalanello, Rebecca. Mother believes her newborn was the first to die from fungus at Children's Hospital in 2008. NOLA.com. 2014-04-16 [2021-05-11]. (原始内容存档于2018-04-01). 
  18. ^ 5 Children's Hospital patients died in 2008, 2009 after contact with deadly fungus. [2021-05-11]. (原始内容存档于2019-01-06). We acknowledge that Children's Hospital is Hospital A in an upcoming article in The Pediatric Infectious Disease Journal. The safety and well-being of our patients are our top priorities, so as soon as a problem was suspected, the State Health Department and CDC were notified and invited to assist in the investigation. The hospital was extremely aggressive in trying to isolate and then eliminate the source of the fungus. 
  19. ^ Weinhold, Bob. Rare Fungal Illness Follows Tornado. Environmental Health Perspectives. 2013-04, 121 (4) [2022-07-28]. ISSN 0091-6765. PMC 3620763可免费查阅. PMID 23548439. doi:10.1289/ehp.121-a116. (原始内容存档于2022-03-02) (英语). 
  20. ^ 'Black' Fungal Disease that Causes Blindness, Death Strikes Guj after Covid-19; Kills 9 in Ahmedabad. News18. 2020-12-18 [2020-12-18]. (原始内容存档于2021-05-11).