Lortholary O, Denning D W, Dupont B
Service de Médecine Interne, Centre de Recherche en Pathologie Infectieuse et Tropicale, Hôpital Avicenne, Université Paris Nord, Bobigny, France.
J Antimicrob Chemother. 1999 Mar;43(3):321-31. doi: 10.1093/jac/43.3.321.
Endemic mycoses remain a major public health problem in several countries and they are becoming increasingly frequent with the spread of HIV infection. Amphotericin B remains the drug of choice during the acute stage of life-threatening endemic mycoses occurring in both immunocompetent and immunocompromised hosts. Ketoconazole is effective in non-AIDS patients with non-life-threatening histoplasmosis, blastomycosis, or paracoccidioidomycosis. Itraconazole is the treatment of choice for non-life-threatening Histoplasma capsulatum or Blastomyces dermatitidis infections occurring in immunocompetent individuals and is the most efficient secondary prophylaxis of histoplasmosis in AIDS patients. Itraconazole is also effective in lymphocutaneous and visceral sporotrichosis, in paracoccidioidomycosis, for Penicillum marneffei infection, and is an alternative to amphotericin B for Histoplasma duboisii infection. Coccidioidomycosis may be effectively treated with prolonged and sometimes life-long itraconazole or fluconazole therapy. Fluconazole has relatively poor efficacy against histoplasmosis, blastomycosis and sporotrichosis. New antifungal agents have been tested in vitro or in animal models and may soon be evaluated in clinical trials.
地方性真菌病在多个国家仍然是一个重大的公共卫生问题，并且随着艾滋病毒感染的蔓延，其发病率日益增加。两性霉素B仍然是免疫功能正常和免疫功能低下宿主发生危及生命的地方性真菌病急性期的首选药物。酮康唑对非艾滋病患者的非危及生命的组织胞浆菌病、芽生菌病或副球孢子菌病有效。伊曲康唑是免疫功能正常个体发生的非危及生命的荚膜组织胞浆菌或皮炎芽生菌感染的首选治疗药物，也是艾滋病患者预防组织胞浆菌病最有效的二线药物。伊曲康唑对淋巴皮肤型和内脏型孢子丝菌病、副球孢子菌病、马尔尼菲青霉感染也有效，并且是杜波伊斯组织胞浆菌感染替代两性霉素B的药物。球孢子菌病可用伊曲康唑或氟康唑长期治疗，有时需终身治疗。氟康唑对组织胞浆菌病、芽生菌病和孢子丝菌病的疗效相对较差。新型抗真菌药物已在体外或动物模型中进行了测试，可能很快会进入临床试验评估。
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