侵犯型鼻腦型白黴菌感染

Invasive Rhino-cerebral Mucormycosis

王哲偉(Che-Wei Wang) ； 蔡曜隆(Yao-Lung Tsai) ； 陳穆寬(Mu-Kuan Chen)

《台灣耳鼻喉頭頸外科雜誌》 47卷1期 (2012/02) Pp. 8-13

https://doi.org/10.6286/2012.47.1.8

摘要

目的：侵犯型鼻白黴菌感染是一種罕見且具有致命性的黴菌感染，好發於糖尿病或免疫不全患者。侵犯型白黴菌感染臨床表現呈現快速的感染，可經由鼻部、鼻竇、眼部侵犯到顧內而造成頭痛、發燒、黏膜壞死、眼睛及中樞神經傷害。本研究的目的在暸解早期正確的診斷及控制其內科疾病再加以積極的清創術和amphotericin-B治療對於本疾病的治療結果。方法：回溯性收集從2001年至2008年之間，在彰化基督教醫院經診斷為侵犯型鼻竇白黴菌感染的7名病患，分析病患年齡、性別、症狀、內科疾病、診斷及治療方式，並採討其預後情形。結果：7名病患其年齡分布為40至72歲，平均年齡為59歲，其中男性4名女性3名。就診時其臨床表現主要以鼻部、眼部症狀為主。所有病人皆為糖尿病患者，造成顱內侵犯有2名。所有患者皆安排電腦斷層掃描或核磁共振攝影檢查，並施以手術清除、amphotericin-B治療及控制其內科疾病。在7名患者中有4名存活佔57%。結論：侵犯型鼻竇白黴菌的感染有較高的致死率，其與患者的免疫狀況、潛在的內科疾病，早期的診斷治療，和是否造成眼部及顱內的侵犯有相關。所以在診治侵犯型鼻竇白黴菌的感染，首先要及早診斷並治療其本身既有的疾病，並以amphotericin-B和積極的手術廣泛清創的方法處置，如此方可提高患者之預後。（台耳醫誌　2012; 47:8-13）

關鍵字

白黴菌 ； 副鼻竇 ； 侵犯型

並列摘要

PURPOSE: Invasive nasal mucormycosis is an uncommon, highly fatal fungal infection, usually occurring in diabetes mellitus or immunocompromised hosts. The usual presentation is that of an acute, fulminant infection that begins in the nose and progresses rapidly through the paranasal sinuses, invading the orbital or extending involvement of the intracranial structures. Many patients presented with headache, fever, mucosa necrosis, orbital and brain lesion. This report aims to clarify the several aspects impact on the disease; namely, early diagnosis, underlying causes control, aggressively debridement and the use of Amphotericin-B.METHODS: In this retrospective study, diagnosis of paranasal sinus mucomycosis was carried out from 2001 to 2008 at Changhua Christian hospital. Datas assessed by the seven cases were patient's age and gender, symptoms and sign, underlying disorders, diagnostic procedure, treatment, and outcome.RESULT: A total of 7 cases of invasive paranasal sinus mucormycosis consisted of 4 male and 3 female aged from 40 to 72 years (mean 59 years). The commom presenting sign and symptom were nasal and ocular damage. All patients had the predisposing illness of diabetes mellitus and two patients had intracranial infection. All the 7 patients were subject to imaging study and endoscopic examination and received combined treatment with surgical debridement and amphotrecin B therapy and control of underlying diseases. 4 of the 7 patients survived and the survival rate was 57%.CONCLUSION: Invasive paranasal sinus mucormycosis is associated with high mortality and morbidity. It's related the immunocompromising state, underlying medical problem, early diagnosis, and the orbital or intracranial invasion. Early diagnosis of paranasal sinus mucormycosis, control of the underlying medical illness, high dosage amphotericin-B, and aggressive surgical debridement are the crucial for survival. (J Taiwan Otolaryngol Head Neck Surg 2012; 47:8-13)

並列關鍵字

mucormycosis ； paranasal sinus ； invasive