- 期刊
Invasive Rhino-Orbital-Cerebral Aspergillosis of Non-immunocompromised Host
非免疫力低下者之鼻-眼-腦麴菌症
摘要
侵襲性麴菌症(Invasive aspergillosis)為麴菌造成之罕見但迅速進展之侵入性感染，與免疫低下者有高度相關，尤其是糖尿病、惡性腫瘤患者及器官移植者，一般多由上呼吸道侵入人體，聚集在鼻竇內進而造成眼部或顱底之局部性侵犯(Rhino-orbital-cerebral aspergillosis)。患者常有頭痛、鼻腔分泌物、視力減退或複視、意識減退或昏迷等症狀，卻不一定有發燒或寒顫等感染症表現，尤其是在較常出現的60-70歲族群及免疫力低下患者，因此常延遲診斷，造成高致死率。診斷鼻-眼-腦麴菌症除病史及理學檢查包括鼻腔內視鏡檢外，影像檢查為一重要之項目。具血管顯影之電腦斷層及核磁共振除提供感染破壞範圍及周邊血管侵犯程度，也做為手術治療之指引。抗黴菌藥物治療以脂溶性之Amphotericin-B為首選，配合外科手術清創，才有可能達到感染控制。本文回顧一66歲健康無糖尿病病史之男性，其因頭痛及漸進性右眼視覺喪失前來求診，經一系列檢查後確立侵襲性麴菌症之診斷。因此開始脂溶性Amphotericin-B靜脈治療及數次經鼻內視鏡清創術將鼻腔及眼眶壞死組織清除，數周治療後患者病況穩定，後續追蹤半年餘無復發跡象。因免疫正常者之鼻-眼-腦麴菌症實屬罕見，加上此案例初期無明顯之影像診斷證據，疾病進程亦較免疫低下者緩慢，因此提出報告。
並列摘要
Fungus may spread into upper respiratory tracts of humans and accumulated in paranasal sinuses, causes fungal sinusitis. Aspergillus is the most found pathogen. Invasive aspergillosis often happens in immunocompromised patents. Orbital or deep cranial symptoms including headache, visual loss, diplopia, cranial nerve paralysis or consciousness disturbance may develop, cause rhino-orbital-cerebral aspergillosis. After physical and endoscopic examination, image studies like CT and MRI are required for preoperative surveillance. Intravenous liposomal Amphotericin-B combined with adequate surgical debridement is regarded as the mostly effective therapeutic strategy for infection control. We reviewed a medical history of the 66 year-old gentleman who had no systemic disease before and diagnosed with rhino-orbital-cerebral aspergillosis. After the treatment, he recovered well and no evidence of recurrence was noted after follow-up for six months.
延伸閱讀
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