毛霉菌病(英语:Mucormycosis),部分媒体称之为黑真菌症(black fungus)[3],是毛霉门真菌感染造成的疾病[4],其中以毛霉属根霉属犁头霉属小克银汉霉属英语Cunninghamella真菌的感染为大宗[5][6]。此感染过去称为接合菌病(Zygomycosis),但接合菌门的分类因为复系群而已不再使用,且接合菌门除毛霉外还有些虫霉目蛙粪霉耳霉)的真菌也可感染人类,现多以毛霉菌病、耳霉病英语conidiobolomycosis[7]蛙粪霉病英语basidiobolomycosis[8]等具体病名称呼。

毛霉菌病
同义词接合菌病(Zygomycosis)[1]
眼窝周围被毛霉菌感染的病患
肇因免疫缺乏
风险因子艾滋病糖尿病淋巴瘤器官移植接受者、长期类固醇使用者
治疗两性霉素B外科清创
预后不良[2]
分类和外部资源
医学专科传染病科
ICD-111F2C
ICD-10B46.0、​B46.5
DiseasesDB31759
MedlinePlus000649
Orphanet73263
[编辑此条目的维基数据]

症状 编辑

 
一名感染毛霉菌病的男子脸部出现红肿的病征,右方为其皮肤样本在电子显微镜下发现毛霉菌的孢子囊[9]

毛霉菌多感染鼻窦脑部肺部等部位,还可感染消化道皮肤以及其他器官[10]。病原进入血管后可能导致血栓,造成周围组织因缺血坏死,若侵染脑部与脸面则会造成单侧头痛、发烧、脸面疼痛、鼻腔阻塞并出现黑色黏液、鼻窦炎以及结膜水肿英语Chemosis等症状[11]。感染初期被侵染的部位表面外观正常,随后迅速转为红肿甚至因坏死而呈黑色[12];感染肺部者则会造成呼吸困难、持续咳嗽、咳血腹痛恶心呕吐等症状[10]

治疗 编辑

艾滋病糖尿病淋巴瘤等癌症、肝硬化肾功能衰竭病患、接受器官移植者以及长期使用皮质类固醇者被毛霉菌感染的风险较高。两性霉素B为治疗此感染的第一线药物,另外艾沙康唑英语Isavuconazonium也可用于治疗此症[13]。药物治疗一段时间后还需开刀移除被感染的组织[10][14],另外高压氧治疗因可能促进嗜中性球的活性而作为此病的辅助疗法。此病的愈后情况一般不佳[12]

预后 编辑

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]

流行病学 编辑

毛霉菌的感染相当罕见[10]。2008年美国的一家医院曾爆发毛霉菌病的院内感染,于2014年才被媒体披露[17][18] 。2011年密苏里州受乔普林龙卷风英语2011 Joplin tornado侵袭后当地爆发毛霉菌病的疫情,有十数人被感染,其中5人死亡[19]

2020年COVID-19疫情期间,印度多个城市爆发毛霉菌病感染[20],2021年印度各地又爆发数起感染,可能与COVID-19重症病患接受类固醇治疗后免疫力降低有关[3]

参考文献 编辑

  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 . 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 . 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 . 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 . 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).