由于在过去的几十年中以及在全球冠状病毒病2019大流行(COVID-19)的背景下,人们对黑化真菌的关注越来越多,病毒本身和糖皮质激素等免疫抑制剂可进一步增加感染的风险深部真菌病,斑纹真菌病(PHM)的患者数量大幅增加。它们的范围很广,早期诊断和治疗非常棘手。本研究旨在更全面地了解我国35年来斑纹真菌病的临床特征,建立更适用的系统分型和病变严重程度分级,以指导治疗和预后。
我们回顾了1987年至2021年中英文文献报道的174例已证实的斑纹真菌病病例,并对流行病学进行了准确的分类定义和详细信息。临床食性真菌的种类,最小抑制浓度值,临床特征,治疗,和预后。
大脑的死亡率,播散性和肺部带真菌病占55%,36%,和25%。近19%的患者因残疾等并发症导致生活质量差,毁容,和失明。带真菌病的总误诊率为74%。中度至重度皮疹占皮下真菌病的82%。头部和面部区域主要受到影响,占严重皮疹的16%。近30%的带真菌病侵袭性感染是由复发性病变引发的。伏立康唑,伊曲康唑,两性霉素B脱氧胆酸(AmB-DOC),和特比萘芬是最常用的,但在现实中,真菌病的诊断和治疗仍然具有挑战性。
我们的分类可能更实用,更容易普及,这些非特异性病变仍然有很多特征。治愈率没有显著差异,或三级病变之间的死亡率。但是严重皮疹的患者病程较长,有效率较低。
Due to more attentions paid to melanized fungi over the past few decades and under the background of the global coronavirus disease 2019 pandemic (COVID-19) the fact that the virus itself and the immunosuppressive agents such as glucocorticoids can further increase the risk of infections of deep mycoses, the number of patients with phaeohyphomycosis (PHM) has a substantial increase. Their spectrum is broad and the early diagnosis and treatments are extremely sticky. This study aims to more comprehensively understand the clinical features of phaeohyphomycosis in China over 35 years and to establish a more applicable systematical classification and severity grades of lesions to guide treatments and prognosis.
We reviewed 174 cases of proven phaeohyphomycosis reported in Chinese and English language literature from 1987 to 2021 and we also made the accurate classification definitions and detailed information about the epidemiology, species of clinical dematiaceous fungi, minimum inhibitory concentration values, clinical features, treatments, and prognosis.
The mortality of cerebral, disseminated and pulmonary phaeohyphomycosis are 55%, 36%, and 25%. Nearly 19% of patients had poor quality of life caused by the complications such as disability, disfigurements, and blindness. The overall misdiagnosis rate of phaeohyphomycosis was 74%. Moderate to severe rashes are accounting for 82% of subcutaneous phaeohyphomycosis. The areas of the head and face are mostly affected accounting for 16% of severe rashes. Nearly 30% of invasive infections of phaeohyphomycosis are triggered by recurrent lesions. Voriconazole, itraconazole, amphotericin B deoxycholate (AmB-DOC), and terbinafine were most commonly used but diagnosis and treatments of phaeohyphomycosis remain challenging in reality.
Our classifications are likely to be more practical and easier to popularize, and there are still also plenty of characteristics in these non-specific lesions. There\'re no significant variations in cure rates, or death rates between three grades of lesions. But patients with severe rashes have longer courses and lower effective rates.