250.3 📌 章末速蚘

  • Mucormycosis: Rhizopus + Mucor + Lichtheimia (Mucorales)
  • Aseptate broad ribbon-like hyphae 90° branching
  • Risk: DM ketoacidosis + iron overload + deferoxamine + immunocompromise + steroids + COVID-19
  • Rhinocerebral form: DKA + black eschar on palate + sinus → orbit → brain (mortality 30-50%+)
  • Pulmonary form: neutropenic + HSCT; cavitary lesions
  • Treatment: liposomal AmB 5-10 mg/kg + EMERGENT surgery + reverse predisposing factors + step-down to isavuconazole / posaconazole
  • Echinocandins + voriconazole NOT active
  • Switch deferoxamine to deferiprone / deferasirox
  • CAM (India 2021) — COVID-associated mucormycosis epidemic
250.3.0.0.1 盧醫垫 hint
  • DM ketoacidosis + facial pain + black palate eschar → EMERGENT surgical + liposomal AmB (time-critical!)
  • Neutropenic + pulmonary cavity + halo/reverse halo → consider mucor in differential of IA
  • Iron overload + deferoxamine + new fungal infection → switch chelator + treat