| Objective:To investigate the clinical characteristics,treatment and prognosis of pulmonary mucormycosis.And improve clinicians'understanding of the disease and reduce misdiagnosis and missed diagnosis.Methods:The clinical data of 8 patients with pulmonary mucormycosis diagnosed and treated in the first affiliated hospital of guangxi medical university form January 1,2004,to June 30,2018 were retrospectively analyzed,and their clinical characteristics were analyzed and summarized.Results:In this study,4 males and 4 females were negative hosts of human immunodeficiency virus(HIV),with an average age of 59.12(range,37-90)years.There were 3 patients with diabetes,1 with chronic obstructive pulmonary disease,2 with healthy hosts,1 with long-term use of immunosuppressive agents combined with glucocorticoid in SLE,and 1 with severe anemia.Clinical symptoms:there were 6 cases of cough and sputum,4 cases of yellow pus sputum,2 cases of bloody sputum,3 cases of fever,4 cases of dyspnea,4 cases of emaciation,2 cases of chest pain,2 cases of hemoptysis and 1 case of asymptomatic physical examination.The white blood cell count was increased in 7 cases and was normal in 1 case,with an average value of 24.75(range,4.6-77.0)10~9/L.Neutrophils were increased in 7 cases,and neutrophils were normal in 1 case,with an average value of 22.95(range,8.5-75)10~9/L.The mean value was 99.5(range,59-126)g/L.Platelet count was decreased in 2 cases,increased in 4 cases,and normal in 2 cases.The mean platelet count was289.87(range,96-541)10~9/L.Abnormal liver function was observed in 2 patients,with increased transaminase,and renal function was observed in 5 patients,with increased creatinine,with an average value of 224(range,205-587)umol/L.Six cases had increased ESR,,with an average of 51.83(range,15-86)mm/h,and five cases had increased CRP,with an average of 106.44(range,6.7-224)mg/L.CD4+decreased by 1 case and CD8+decreased by 1 case.Hypoxemia was suggested in 3 patients,type I respiratory failure in 3 patients,and type II respiratory failure in 1 patient.Abnormal blood glucose in 3 cases.The main imaging findings were bilateral lesions,including 7 cases of exudation,3 cases of consolidation,1 case of nodular shadow,1 case of bronchogram,4 cases of pleural effusion,2 cases of pericardial effusion and 2 cases of ascites.All the 8cases had the basis of pulmonary etiology,2 cases were found to have the typical mucor by b-ultrasound-guided percutaneous lung puncture,2 cases by TBLB lung histopathological examination,3 cases by sputum culture,1 case by sputum culture and growth of mucor by BALF culture.Two patients were misdiagnosed as pulmonary aspergillus,and were treated with voriconazole and itraconazole.Among them,1 patient gave up the treatment due to deterioration,and 1 patient was finally diagnosed as pulmonary mucor and cured by amphotericin B liposome.2 patients were initially treated with amphotericin B liposomes after diagnosis,of which 1 patient was discharged automatically due to MODS and 1patient was cured.After diagnosis,1 patient was discharged from hospital and received surgical treatment in another hospital.2 patients were treated with fluconazole and 2 died of MODS.1 case died of MODS without treatment.The overall mortality rate was 37.5%.Conclusion:Pulmonary mucormycotic is an opportunistic fungal disease,mostly occurring in patients with low immune function or organ failure and can also occur in healthy hosts with HIV-negative and no underlying diseases.The clinical manifestations are non-specific,and respiratory symptoms such as cough,expectoration,dyspnea,fever and hemoptysis are common,and there may be no symptoms or MODS.Imaging has a variety,mainly exudation,consolidation shadow,common pleural effusion and cavity,clinical easily misdiagnosed as pulmonary aspergillosis.The pathology showed inflammatory exudate with massive necrosis,granulation tissue,polynuclear giant cells,epithelioid nodules,and neutrophil infiltration.PAS or D-PAS staining(+),coarse hyphae can be seen under the microscope,and the mycelium and mycelium are angular(right or obtuse),which can be distinguished from aspergillus.Amphotericin B liposome is the only effective antifungal drug for the treatment of mucormycotic at present,but it has a poor prognosis and a high mortality rate,mostly due to MODS. |
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