Galgiani J N
Veterans Affairs Medical Center and University of Arizona, Tucson, USA.
Ann Intern Med. 1999 Feb 16;130(4 Pt 1):293-300. doi: 10.7326/0003-4819-130-4-199902160-00015.
Coccidioidomycosis is an increasingly important health problem because of the migration of large numbers of persons to portions of the southwestern United States in which the disease is endemic and because of the increasing numbers of immunosuppressed patients. Most infections due to Coccidioides immitis, although causing significant illness, are self-limited and resolve over a period of weeks to months without specific treatment. It is not known whether antifungal treatment of early infections hastens resolution of the primary illness or prevents complications. Even so, diagnosis of early infections is of value for allaying patient anxiety, lessening the need for further diagnostic studies, decreasing empirical use of antibacterial agents, and facilitating early identification of patients with complications that are more serious. Patients who develop chronic coccidioidal pneumonia or extrapulmonary infection often have complicated courses that require the involvement of various medical, surgical, and radiologic subspecialties for management. Improvement of the ability to control the problem of coccidioidomycosis will require research into the molecular and cellular biology of C. immitis, vaccine development to prevent coccidioidal infection, a better understanding of the soil ecology that supports the fungus in its endemic regions, and discovery of new antifungal drugs. In addition, government agencies, colleges, the military, and employers could improve public health by initiating education programs about the most common manifestations of the disease among persons at risk for infection.
球孢子菌病正成为一个日益重要的健康问题，这是由于大量人口迁移到美国西南部该病的地方性流行地区，以及免疫抑制患者数量不断增加。大多数由粗球孢子菌引起的感染，尽管会导致严重疾病，但具有自限性，在数周数月内无需特殊治疗即可痊愈。早期感染进行抗真菌治疗是否能加速原发性疾病的痊愈或预防并发症尚不清楚。即便如此，早期感染的诊断对于缓解患者焦虑、减少进一步诊断检查的必要性、减少抗菌药物的经验性使用以及促进对更严重并发症患者的早期识别仍具有价值。发生慢性球孢子菌性肺炎或肺外感染的患者病程往往复杂，需要多个医学、外科和放射科亚专业参与管理。提高控制球孢子菌病问题的能力需要对粗球孢子菌的分子和细胞生物学进行研究、开发预防球孢子菌感染的疫苗、更好地了解支持该真菌在其地方性流行地区生存的土壤生态学以及发现新的抗真菌药物。此外，政府机构、学院、军队和雇主可以通过启动针对感染风险人群中该病最常见表现的教育项目来改善公众健康。
