???????? ????? ??????? ???? ????? , ??????? ???????? ?????? ???? ?? ??? ???? ?? ???? ??????? ??????? ????? ?? ???????? ?: ???? ????

????????????? ?? ?

????????????? (Mucormycosis) ??? ??????? ??? ????????????? (Zygomycosis) ???? ???? ??? ????? ?????? ???? ???? ????????? ??????(Order – Mucorales) ????????? ????????? (Family – Mucoraceae) ?? ????????? ???????? ??????? ???????? ????????????? ??? ?????? ??, ???? ????? – ?? ????????? ????????????? ??????? ???? ?????? ??? Black Fungus Disease ???? ?????? ??? ??????

?? ?????? ????? ???? ?

?????? ??????? ???????? ?? ?????? ???????? ??????? ???? ?????
?????? ??? ?????? ??????? ??? ?????? ???? ????? ????, ????? ??????????, ??????? ??? ?? ?? ???? ??????????, ?????? ??????? ?? ???? ????? ?????????? ????, ?????? ???? ????? ????????, ??? ??? ???????? ????? ?????? ??????? ?????
?? ???????? ???? ??? ????? ????????? ???? ?????? ???? ???? ??????? ????, ???????? ?? ???????? ?????? ?? ???????? ???? ?????

??????????? ?????? ??? ???? ?? ? ??????, ?? ??? ?????? ???? ????????????? ??????? ??? ??? ???????? ????????????? ????? ?????, ???????? ???? ?????? ???? ??? ?????? ??????, ????????????? ??????? ?? ???????? ????? ????? ?????? ?????
????? -?? ????????? ????????????? ???? ?????? ?? ??????? ???????? ?????? ????? ??????? ?????, ???? ???????-?????? ??? ?????, ???? ????, ????????????? ?????? ????? ??? ?????? ??????? ???? ? ?????? ???????? ????? ?????? ???????? ???? ??? ?? ?????????? ?????? ???? ?????????

??? ??? ?????? ?? ????????????? ??? ?????? ??? ?

????????? ?????? (Order – Mucorales) ????????? ????????? (Family – Mucoraceae) ???????? ???????? ???????? ???? ???? ????????????? ??? ???? ?? ????? ??????????? ??? :
Rhizopus species (viz. Rhizopus arrhizus, Rhizopus microsporus, Rhizopus homothallicus),
Mucor species (viz. Mucor irregularis),
Rhizomucor species,
Syncephalastrum species,
Cunninghamella bertholletiae,
Apophysomyces species (viz. Apophysomyces variabilis),
Lichtheimia (formerly Absidia) species,
Saksenaea erythrospora,
Thamnostylum lucknowense.

??????????????? ??????? ????????? :

?????????????? ????????????? : ??? ? ?????? ??????? ??????? ?? ??????? ???? ???? ???? ??? ??????? ???????? ??? ???? ??????? ????? ???? ???????? ???????? ????? ??????????? ???? ?????? ???????? ????? ???????????? ?????????? ???? ????? ??????????? ?????? ??? ??????? ???????? ?? ??? ???? ????
?????????????? ????????????? ????? ????? :
• ????? ?????? ??? ???? ???? ????/???,
• ????? ????????? ??????? ??? ????? ??? ?????? ???? ???? ????,
• ??? ???? ???? ???? ??? ??????,
• ????? ??? ??? ??????? ?????? ???????? ????? ???? ????,
• ?????? ?????? ????,
• ???? ??? (????? ???),
• ????? ?????? ?????, ????,
• ???????? ??? ????? ????, ???? ???? ??????? ???? ????,
• ????? ????????, ???? ?????,
• ??? ??? ??????? ????? ???, ??????? ????,
• ???? ??????, ??? ????, ????? ???????? ?? ????? ?????? ?????

??????? 30 ???? 70 ????? ???????? ????? ??????? ???????? ?? ????? ????????? ??? ?????
????????? ????????????? : ?? ??????? ?????? ???????? ????? ???? ????????? ???????? ??????? ??? ?????????? ???? ???? ???? ??????????? ?????? ?? ????? ??? ???????????? ?????? ??? ??????? ???????? ?? ????? ??? ???? ???? ?????

????????? ????????????? ????? ????? :

• ????,
• ???? ?????,
• ?????????,
• ?????,
• ????????????? ??????? ???? ?????????,
• ???????? ???? ?? ??? – ?? ???? ????? ?????? ?????
????????????????????? ????????????? : ?? ????? ??????? ????????? ??????? ??????? ???? ???? ????? ?????? ?? ????? ???? – ???? ?????? ??? ??????? ??? ????? ?? ????? ?? ????, ???? ???? ?????????????????? ????????? ??????, ??? ???????? ?????? ?? ????????? ???? ??? ???? ???? ?????, ???? ?????? ??? ??????? ???????? ?? ??? ???? ?????

????????????????????? ????????????? ????? ????? :

• ???? ?????,
• ??? ??? ???,
• ??? ??? ???,
• ??? ?????,
• ??? ???? ??????,
?????????????????????? ???? ??????? ??? – ?? ????? ?????? ?????? ??????
?????????? ????????????? : ???????? ???? ???? ???? ??? ???????? ?? ????? ????? ???? ????? ??? ???????? ???? ????? ???? ????? ??? ??????? ????? ??? ???????? ????? ????????? ??? ?? ??? ???? ????????-???????????? ????????? ??? ??? ?????? ???? ???? ????????? ??? ????? ???? ???? ???????? ?????

?????????? ????????????? ????? ????? :

• ?? ????? ??????? ???? ???? ???? ???,
• ????? ??????? ???? ???? ??? ???? ????,
• ????????, ????,
• ?????? ?????? ???? ??????, ??????? ???, ??? ??? ??? ???? ?????
??????????? ????????????? : ?????? ????? ?? ????????????? ???? ???????? ??? ?????? ??????? ?????? ?????? ????? ???? ???? ??? ?????? ??????? ????? ??????? ???? ?????????? ?????? ????? ??????, ????????, ????????, ???? ???????? ????? ????? ???? ?????? 90 ????? ???????? ?? ????? ?????????? ??????? ????? ???????? ?? ??? ??? ?????? ????????

??????????? ????????????? ????? ????? :

• ?????????? ?? ??????? ????? ?????? ?????? ????? ????,
• ???? ?????????? ??????? ???? ????????? ?????? ????? ???? ???? ?????
• ??????????????? ?????????????? ???????? (Predisposing factors of Mucormycosis) :
• ????????????????? (??????? ?? ?? ???? ??????????),
• ????????????,
• ????? ????? ???????? ??????? ??????????????? ??? ????????? ?????? ????????? ???? ???? ????,
• ????????,
• ???? ???????????,
• ????????????? (?????? ?????????? ??????? ?????),
• ??????????,
??????????? ?????? (?????? ???? ????? ???????? ???????)?

????? ???????? ????????????? ??????? ???? ?

• ????????? ?? ????? -?? ???????
• ?????????? ???????? ???????
• ???????? ??? ???????? ???????
• ????????????? ???? ???? ???????? ??? ?????? ?? ??????

????????????? ??????? ???? ???? ?? ?

1. ????? ?????? ?? ??? ????? ??? ??? ????????? ??? ??? ????? ??? ????? ?????? ???? ???? ?????? ??????, ???? (???? ??? ???? ???? ??), ?????????? ???????, ???????????
2. ??????????????? ???? ????? ???????? ?? ????? ?? ??? ????????? ????? ?????? ??? ?????? ?????????? ??? ??? ????????? ??????? ??? ????? ??? ??? ???????? ??????
3. ?????? ?? ???? ? ?????? ???????? ???? ????? ?????????? ?? ??????? ???????? ????????? ???? ???????? ????????? ????? ??????? ???? ?????
4. ???? ?? ??? ???????? ??????? ???????? ?????? ????? ???? ???????? ????? ????????? ???? ???? ???????? ???????? ????????????? ??????? ??? ?????

????? ??????? :

????? ???? ??? ???????????? ??????? ????? (?????????????),
????? ???? ??? ????????????????? ???????,
????????????? ????????????? (???? : ??????????, ????????, ???????),
????????????? ??????????,
???? ??????????? ???? ????? ??? ???????????,
??????? ???????,
??????????,
?????????? ???????????????,
????? ??????? ????????? ???????? ????????,
?????????? ???? ??? ????,
?????, ?????????,
???????,
?????? ??? ??????? ???? ???
????? ????? ????????

????? ???????? ??????? ????????? ??????? ???? – ????????, ??????? ??? ?????? (Ref. 2004 ?????? ??????? ??????-????? ??????? ??????? ????? ????) ??????? ????? ???? ?????????? ??????????? ???????? ?? ??????????? ???? ???????? ????????? ????????

??????? ?????????? :

?????????? ??????? ????????? ? ?????? ?????? ??????? ???? ???? ?? ?????????? ?????? ??? ????? ?? ???????? :

1. Amphotericin B deoxycholate (D-AmB) : 1.0-1.5 mg/kg/day
2. Liposomal amphotericin B (L-AmB) (Preferred Treatment) : 5-10 mg/kg/day
3. Injection Amphotericin B Lipid Complex : 5 mg/kg/day
4. Adequate hydration
5. Monitor renal function and serum potassium

????? ??????????????? ???????? ???? ???????? ????????????? ????????????? ?????? ??? ????? ???????? ???????? ??? ??????????????? ?????? ?????? ??????? ??? ?????? ?????? ????? ???? ???? ???????? Amphotericin B ? Posconazole ?????? ??????? ??? ????????? ??????? ???????? ?????? ?????? ??????? ??? ???
????? ????????

????? -?? ??????????? ???? ?????? ????????? ?????? ?????????? ???? ???? ???????? ???? ??????? ????????????????? ??????? ???? ??? ????? ?????????? ?????? ?????? ??? ????? ????? -?? ??????? ???????? ??? ????? ???? ??? ??????? ???? ????????????? ??? Black Fungus Disease ????????? ??? ?????