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Zygomycosis in children: a systematic review and analysis of reported cases.

机译:儿童Zygomycosis:对报告病例的系统回顾和分析。

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BACKGROUND: Zygomycosis has emerged as an increasingly important infection with a high mortality especially in immunocompromised patients. No comprehensive analysis of pediatric zygomycosis cases has been published to date. METHODS: We used a PUBMED search for English publications of pediatric (0-18 years) zygomycosis cases and references from major books as well as single case reports or case series. Individual references were reviewed for additional cases. Data were entered into Filemaker-pro database and analyzed by logistic regression analysis. RESULTS: One hundred fifty-seven cases (64% male) were found with median age 5 years (range, 0.16-13). Underlying conditions included neutropenia (18%), prematurity (17%), diabetes mellitus (15%), ketoacidosis (10%), and no apparent underlying condition (14%). The most common patterns of zygomycosis were cutaneous (27%), gastrointestinal (21%), rhinocerebral (18%), and pulmonary (16%). Among 77 culture-confirmed cases, Rhizopus spp. (44%) and Mucor spp. (15%) were most commonly identified. Of 81 patients who were given antifungal therapy, 73% received an amphotericin B formulation only. The remaining patients received mostly amphotericin B in combination with other antifungal agents. Mortality in patients without antifungal therapy was higher than in those with therapy (88% versus 36%, P < 0.0001). Ninety-two (59%) patients underwent surgery. Cerebral, gastrointestinal, disseminated and cutaneous zygomycosis were associated with mortality rates of 100, 100, 88, and 0%, respectively. Independent risk factors for death were disseminated infection (OR: 7.18; 95% CI: 3.02-36.59) and age <1 year (OR: 3.85; 95% CI: 1.05-7.43). Antifungal therapy and particularly surgery reduced risk of death by 92% (OR: 0.07; 95% CI: 0.04-0.25) and 84% (OR: 0.16; 95% CI: 0.09-0.61), respectively. CONCLUSIONS: Zygomycosis is a life-threatening infection in children with neutropenia, diabetes mellitus, and prematurity as common predisposing factors, and there is high mortality in untreated disease, disseminated infection, and age <1 year. Amphotericin B and surgery significantly improve outcome.
机译:背景:真菌病已成为一种越来越重要的感染,死亡率很高,尤其是在免疫功能低下的患者中。迄今为止,尚未发表有关小儿虫病病例的全面分析。方法:我们使用PUBMED搜索小儿(0-18岁)合子菌病病例的英文出版物以及主要书籍以及单个病例报告或病例系列的参考文献。个别参考文献进行了复审。将数据输入Filemaker-pro数据库并通过逻辑回归分析进行分析。结果:发现157例(64%男性)中位年龄为5岁(范围0.16-13)。潜在疾病包括中性粒细胞减少症(18%),早产(17%),糖尿病(15%),酮症酸中毒(10%)和无明显潜在疾病(14%)。 zy虫病的最常见模式是皮肤(27%),胃肠道(21%),鼻脑(18%)和肺部(16%)。在77例经文化确认的病例中,根霉属。 (44%)和Mucor spp。 (15%)是最常见的。在接受抗真菌治疗的81位患者中,有73%仅接受两性霉素B制剂。其余患者主要接受两性霉素B与其他抗真菌药联合治疗。未接受抗真菌治疗的患者的死亡率高于接受抗真菌治疗的患者(88%比36%,P <0.0001)。九十二(59%)名患者接受了手术。脑,胃肠道,弥散性和皮肤合胞菌病的死亡率分别为100%,100%,88%和0%。死亡的独立危险因素是传播感染(OR:7.18; 95%CI:3.02-36.59)和年龄<1岁(OR:3.85; 95%CI:1.05-7.43)。抗真菌治疗(尤其是手术)分别将死亡风险降低了92%(OR:0.07; 95%CI:0.04-0.25)和84%(OR:0.16; 95%CI:0.09-0.61)。结论:Zygomycosis是中性粒细胞减少,糖尿病和早产是常见诱因的威胁儿童生命的感染,未经治疗的疾病,传播性感染和1岁以下的儿童死亡率很高。两性霉素B和手术显着改善了预后。

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