肾衰竭合并毛霉菌病

Mucormycosis in a patient with renal failure:case report and review of literatures

目的探讨肾衰竭合并毛霉菌病的临床特点、诊断、治疗及预后。方法报道1例慢性肾衰竭合并肺毛霉菌病,并使用二性霉素B治疗成功的病例;结合该例的特点,复习肾衰竭合并毛霉菌病的文献资料,不包括存在明确易感因素如腹膜透析相关性的毛霉菌性腹膜炎及去铁胺治疗者。结果共15例,平均年龄(49.9±15.8)岁。鼻脑型占46.7%,其次为肺型和弥漫型,分别占33.3%和20%。46.7%于死亡后尸检诊断,总死亡率为73.3%。7例接受治疗者,死亡率为42.9%。未接受治疗者,无1例存活。结论毛霉菌病是肾衰竭患者致死性的感染性疾病,早期诊断、及时联合使用大剂量抗真菌药物、外科清创术或局部引流是改善预后的关键。

Objective To investigate clinical characteristics, diagnosis, treatment and prognosis of mucormycosis in patients with renal failure. Methods We reported a 65-year old case of mucormycosis with chronic renal failure. The patient was successfully treated with amphotericin B. Mucormycosis complicated with renal failure were reviewed excluding mueormycosis peritonitis associated with peritoneal dialysis and desferrioxamine-related mucormycosis. Results Fifteen cases including our case were involved with mean age of 49. 87 ± 15. 84 years old. Rhinocerebral, pulmonary, and disseminated forms accounted for 46.7% , 33.3% and 20% respectively. Autopsy was made in 46. 7% of patients. Mortality was 73.3% in all of them and 42. 9% in seven patients who received antifungal therapy. All patients without treatments died. patients age and Mucormycosis is a lethal invasive infection in with renal failure. The management to improve prognosis are early diagnosis, surgical debridement, drainaggressive antifungal chemo-therapy.