战伤的侵袭性真菌病:负担、流行病学和真菌学。

IF 3.6 3区 生物学 Q2 MYCOLOGY
Ashleigh Roberds, Alexander G Bobrov, Riina Rautemaa-Richardson, Thomas J Walsh
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引用次数: 0

摘要

在过去二十年里,伤口侵袭性真菌病(WIFDs)再次成为战争地区军人和平民伤亡的重要致死和发病原因。历史上,越战期间在作战行动中获得的真菌感染与烧伤有关。现代与作战有关的 WIFD 几乎都与严重创伤事件有关,包括以爆炸为主要致伤机制、随后的四肢截肢和大量失血。此类感染通常会导致深层组织坏死、长期住院、广泛手术和更严重的截肢。对阿富汗 "持久自由行动"(Operation Enduring Freedom)中的美军人员进行的与作战相关的 WIFD 研究表明,发病率约为 7%,粗死亡率为 8.5%。从阿富汗返回的英国军人中也出现了 WIFD,在当前的乌克兰和加沙冲突中也很常见。粘菌、曲霉和镰刀菌是 WIFD 的主要致病菌。这些霉菌是机会性病原体,在外伤后免疫系统失衡的患者体内大量繁殖。它们是无处不在的环境真菌,存在于各种土壤中,但由于当地的土壤类型、植被和气候不同,地区差异也很大。由于目前的抗真菌药物对许多这类环境真菌的疗效有限,而且全球范围内出现了抗真菌抗药性,因此对 WIFD 的管理变得更加复杂。本综述概述了与作战有关的真菌感染的全球负担、流行病学和临床特征,旨在让人们更好地了解真菌感染对受伤军人和平民造成的威胁。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Invasive Fungal Diseases of Combat Wounds: Burden, Epidemiology, and Mycology.

During the last two decades, wound invasive fungal diseases (WIFDs) have reemerged as important causes of mortality and morbidity in military personnel and civilian casualties in war areas. Historically, mycotic infections acquired in combat operations during Vietnam War and were associated with burn wounds. Modern combat related WIFDs are almost exclusively associated with severe traumatic events which encompass blast exposure as the primary mechanism of injury and subsequent extremity amputation and extensive blood loss. Such infections often lead to deep tissue necrosis, long hospitalizations, extensive surgeries, and more severe amputation. Studies of combat related WIFDs among U.S. military personnel in Operation Enduring Freedom (Afghanistan) demonstrated incidence rates of approximately 7% and crude mortality of 8.5%. WIFDs were also seen in U.K. military personnel returning from Afghanistan and are common in the current Ukraine and Gaza conflicts. Mucorales, Aspergillus and Fusarium species are the predominant causes of WIFDs. These molds are opportunistic pathogens which thrive in patients with immune system imbalances following traumatic injury. They are ubiquitous environmental fungi found in a variety of soils but there are significant regional differences depending on the local soil type, vegetation, and climate. The management of WIFDs is complicated by the limited efficacy of current antifungals on many of these environmental species and by emerging antifungal resistance globally. This review provides an overview of the global burden, epidemiology, and clinical features of combat-related fungal infections with the aim to provide a better understanding of the threat posed for wounded Service Members and civilians.

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来源期刊
Mycopathologia
Mycopathologia 生物-真菌学
CiteScore
6.80
自引率
3.60%
发文量
76
审稿时长
3 months
期刊介绍: Mycopathologia is an official journal of the International Union of Microbiological Societies (IUMS). Mycopathologia was founded in 1938 with the mission to ‘diffuse the understanding of fungal diseases in man and animals among mycologists’. Many of the milestones discoveries in the field of medical mycology have been communicated through the pages of this journal. Mycopathologia covers a diverse, interdisciplinary range of topics that is unique in breadth and depth. The journal publishes peer-reviewed, original articles highlighting important developments concerning medically important fungi and fungal diseases. The journal highlights important developments in fungal systematics and taxonomy, laboratory diagnosis of fungal infections, antifungal drugs, clinical presentation and treatment, and epidemiology of fungal diseases globally. Timely opinion articles, mini-reviews, and other communications are usually invited at the discretion of the editorial board. Unique case reports highlighting unprecedented progress in the diagnosis and treatment of fungal infections, are published in every issue of the journal. MycopathologiaIMAGE is another regular feature for a brief clinical report of potential interest to a mixed audience of physicians and laboratory scientists. MycopathologiaGENOME is designed for the rapid publication of new genomes of human and animal pathogenic fungi using a checklist-based, standardized format.
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