รายงานผู้ป่วยโรคเบาหวานที่มีการติดเชื้อรามิวคอร์ที่ปอด ในสถาบันโรคทรวงอก
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2009-12-22
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Thai Journal of Tuberculosis Chest Diseases and Critical Care
Abstract
Abstract: Siripataravanit S. Diabetic patients with localized pulmonary mucormycosis in Chest Disease Institute.Thai J Tuberc Chest Dis Crit Care 2009; 30: 53-62.Chest Disease Institute, Department of Medical Services, Ministry of Public HealthIntroduction: Pulmonary mucormycosis is an uncommon, but important, opportunistic fungal pneumonia which isoften diagnosed post mortem. Delay in diagnosis may lead to high mortality.Objective: This review emphasizes clinical and pathologic characteristics of pulmonary mucormycosis amongdiabetes mellitus (DM) patients.Material and Methods: Medical records (age, sex, underlying diseases, symptoms, signs, and outcomes),pathology reports, chest radiographs, CT chest of 3 cases of pathologically proven pulmonary mucormycosis inChest Disease Institute between January 1, 1997 and July 31, 2008 were retrospectively reviewed.Results: There were 3 cases with pathologically proven pulmonary mucormycosis (2 male, 1 female, mean age61 years, range 49-74 years). The mean duration of the disease before treatment was 4 months (range 1-9months). The common clinical presentations were productive cough (n=3) and hemoptysis (n=2). Physicalexaminations were normal (n=2) and rhonchi (n=1). Abnormalities seen on chest radiographs and CT chestincluded mass like lesion in upper lobe (n=2; 1 left, 1 right) and consolidation at left upper lobe (n=1).Endobronchial appearance by fiberoptic bronchoscopy were mass-like lesion (n=2) and mucopurulent discharge(n=1). Culture from clinical specimens were negative in all patients. All patients had successful treatment withamphotericin B and surgery.Conclusion: Pulmonary mucormycosis infections are still uncommon, but the incidence in the immunocompromisedhost and diabetic patients has increased significantly. Early consideration of this diagnosis, along with aggressivediagnostic evaluation, are critical to effective therapy and patient survival. While treatment with amphotericin B isthe mainstay of therapy for pulmonary mucormycosis, diabetics with endobronchial disease may benefit from early,aggressive surgical resection of the involved lung tissue.
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Thai Journal of Tuberculosis Chest Diseases and Critical Care; Vol.30 No.1 January-March 2009; 53-62