毛霉病
医学
泊沙康唑
干预(咨询)
疾病
重症监护医学
两性霉素B
多学科方法
医学真菌学
指南
外科
抗真菌
病理
皮肤病科
政治学
法学
微生物学
精神科
生物
作者
Oliver A. Cornely,Ana Alastruey‐Izquierdo,Dorothee Arenz,Sharon C.‐A. Chen,Éric Dannaoui,Bruno Hochhegger,Martin Hoenigl,Henrik Elvang Jensen,Katrien Lagrou,Russell E. Lewis,Sibylle C. Mellinghoff,Mervyn Mer,Zoi Dorothea Pana,Danila Seidel,Donald C. Sheppard,Roger Wahba,Murat Akova,Alexandre Alanio,Abdullah M. S. Al‐Hatmi,Sevtap Arıkan-Akdağlı
标识
DOI:10.1016/s1473-3099(19)30312-3
摘要
Mucormycosis is a difficult to diagnose rare disease with high morbidity and mortality. Diagnosis is often delayed, and disease tends to progress rapidly. Urgent surgical and medical intervention is lifesaving. Guidance on the complex multidisciplinary management has potential to improve prognosis, but approaches differ between health-care settings. From January, 2018, authors from 33 countries in all United Nations regions analysed the published evidence on mucormycosis management and provided consensus recommendations addressing differences between the regions of the world as part of the "One World One Guideline" initiative of the European Confederation of Medical Mycology (ECMM). Diagnostic management does not differ greatly between world regions. Upon suspicion of mucormycosis appropriate imaging is strongly recommended to document extent of disease and is followed by strongly recommended surgical intervention. First-line treatment with high-dose liposomal amphotericin B is strongly recommended, while intravenous isavuconazole and intravenous or delayed release tablet posaconazole are recommended with moderate strength. Both triazoles are strongly recommended salvage treatments. Amphotericin B deoxycholate is recommended against, because of substantial toxicity, but may be the only option in resource limited settings. Management of mucormycosis depends on recognising disease patterns and on early diagnosis. Limited availability of contemporary treatments burdens patients in low and middle income settings. Areas of uncertainty were identified and future research directions specified.
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