13例毛霉菌性肺炎调查分析

Pulmonary Mucormycosis in 13 Cases and Review of Literature

目的分析13例毛霉菌性肺炎的临床表现及诊治经过,了解毛霉菌性肺炎的疾病特点,为临床早期防治提供线索。方法对医院2002-2006年诊断的13例毛霉菌性肺炎患者(其中确诊病例1例,临床诊断病例12例)进行回顾性分析,分析毛霉菌性肺炎患者的临床和影像学表现、诊断、治疗效果及预后。结果毛霉菌性肺炎多发生于白血病、重症肝炎、糖尿病并酮症酸中毒等有严重基础疾病的患者;咳嗽、咳痰(76.9%)、咯血(53.8%)、呼吸困难(46.2%)及发热>38℃(53.8%)为主要临床表现;肺部渗出性阴影(69.2%)、空洞形成(38.5%)及胸腔积液(38.5%)为主要胸部影像学表现;多数患者其病情发展快,过程凶险,死亡率高达84.6%,疾病的愈后与基础疾病的严重程度密切相关。结论毛霉菌性肺炎临床表现无特异性,死亡率高,对具有高危因素的、临床抗感染无效的肺炎患者要怀疑毛霉菌性肺炎的诊断,早期病理学证据对于愈后尤为重要。

OBJECTIVE To analyze the clinical characterization of the pulmonary mucormycosis. METHODS All the cases were divided into proven cases（n= 1） and probable cases（n= 12） according to the definitions of Europen Organization for Research and Treatment of Cancer/National Institute of Allergy and Infectious Disease Mycosis Study Group（EORTC/MSG）. Patient＇s symptoms, physical examinations, radiograph images and treatment were analyzed. RESULTS From the literature and the 13 cases, the underlying predisposing conditions of pulmonary mucormycosis were teukemia,neutropenia, diabetes mellitus with ketoacidosis, long term used corticosteroid and immunsuppression patients. Sputum（76.9%）, hemoptysis（53.8%）, dyspnea（46.2%）and fever（53.8%） were the most commonly symptoms. Infiltrate shadow（69.2 %）, cavity（38.5 %） and pleural effusion（38.5%） were the most radiographic manifestations. Most of patients has associated with a dramatically worse outcome, the mean time from the positive result of mucormycosis to death were only 1-5 days with the mortality and of 84. 6%. CONCLUSIONS For patients with high-risk factors, especially for patients who had no effect after antibiotic therapy the pulmonary mucormycosis must be early suspicious. Histopathological examination is vital to early diagnosis and treatment.