急性猛暴性侵襲性黴菌性鼻竇炎之臨床經驗

Acute Fulminant Invasive Fungal Sinusitis

王鐙慶(Teng-Chin Wang) ； 羅宏一(Hung-I Lo) ； 方深毅(Sheen-Yie Fang)

《台灣耳鼻喉頭頸外科雜誌》 47卷4期 (2012/12) Pp. 295-303

https://doi.org/10.6286/2012.47.4.295

摘要

背景：急性猛暴性侵襲性黴菌性鼻竇炎是一種快速進展且高死亡率的黴菌性感染性疾病。好發於免疫不全的病患（如：糖尿病、惡性腫瘤病患等）。我們提出本院12名治療此類病患之臨床經驗，來探討影響預後的因子以及治療方式。方法：我們收集自1996年1月至2010年12月間，藉由醫院電腦資料庫內之臨床資料，找出符合急性猛暴性侵襲性黴菌性鼻竇炎診斷之病患共12名。針對其潛在危險因子、臨床表徵、黴菌培養結果、處理方式、併發症以及預後做分析。結果：病患年齡分布從12歲到83歲，共12名病患。10名病患為糖尿病患者，其中4名到院時合併糖尿病酮酸血症。1名為急性淋巴性白血病患者併嗜中性白血球低下。初始症狀最常見為鼻部症狀（鼻漏、鼻出血等），其次為臉頰部症狀（腫脹、麻木感或疼痛）。所有病患皆經廣泛性清創手術及抗黴菌藥物治療。大部分病患皆有鼻竇外侵犯，其中9名合併眼部侵犯，6名病患合併顱內侵犯，1名合併全身性侵犯（經血液擴散至肺部）。住院天數從14天到58天，共計6名死亡，總死亡率為50%，死亡個案皆為合併顱內侵犯之病患。結論：急性猛暴性侵襲性黴菌性鼻竇炎為一嚴重之黴菌感染性疾病，併發顱內侵犯時常有高致死率。除了反覆廣泛性清創並使用抗黴菌藥物外，積極矯正病患本身潛在之疾病以求提升病患本身之免疫能力，才能達到最佳治療效果。

關鍵字

猛暴性 ； 黴菌鼻竇炎 ； 侵襲性 ； 白黴菌感染症 ； 接合黴菌感染症

並列摘要

BACKGROUND: Acute fulminant invasive fungal sinusitis (AFIFS) is a rapidly progressing fungal infectious disease with a high mortality rate. The disease is commonly seen among patients with immune deficiencies, such as patients with diabetes and malignant tumors. The present study examined 12 cases of AFIFS to discuss the factors that impact the prognosis and treatment plan of these patients.METHOD: Clinical data dating from January of 1996 to December of 2010 was collected through the hospital computer database, and 12 confirmed AFIFS cases were identified. The potential risk factors, clinical symptoms, fungal culture results, treatment methods, complications, and prognoses of these 12 cases were then further evaluated.RESULTS: The ages of the 12 patient ranged from 12 to 83 years old. Ten of the 12 patients were diabetic, and 4 of those diabetic patients had accompanying diabetic ketoacidosis (DKA) upon arrival at the hospital. One had acute lymphocytic leukemia accompanied with neutropenia. The most common primary symptoms were nose symptoms (including eschar, necrosis and epistaxis), while the most common secondary symptoms were facial-cheek symptoms (including swelling, numbness, and pain).CONCLUSIONS: AIFRS is a severe fungal infectious disease with a high mortality rate when accompanied with intracranial invasions. Aside from repetitive extensive debridement and the use of antifungal drugs, proactively correcting the underlying diseases of patients to improve their immunity is the only way to achieve optimal treatment efficiency.

並列關鍵字

fulminant ； fungal sinusitis ； invasive ； mucormycosis ； zygomycosis