Wheat J, Sarosi G, McKinsey D, Hamill R, Bradsher R, Johnson P, Loyd J, Kauffman C
Department of Medicine and Pathology, Indiana University School of Medicine, Indianapolis 46202, USA.
Clin Infect Dis. 2000 Apr;30(4):688-95. doi: 10.1086/313752. Epub 2000 Apr 20.
The objective of this guideline is to provide recommendations for treating patients with the more common forms of histoplasmosis. PARTICIPANTS AND CONSENSUS PROCESS: A working group of 8 experts in this field was convened to develop this guideline. The working group developed and refined the guideline through a series of conference calls.
The goal of treatment is to eradicate the infection when possible, although chronic suppression may be adequate for patients with AIDS and other serious immunosuppressive disorders. Other important outcomes are resolution of clinical abnormalities and prevention of relapse.
The published literature on the management of histoplasmosis was reviewed. Controlled trials have been conducted that address the treatment of chronic pulmonary and disseminated histoplasmosis, but clinical experience and descriptive studies provide the basis for recommendations for other forms of histoplasmosis. VALUE: Value was assigned on the basis of the strength of the evidence supporting treatment recommendations, with the highest value assigned to controlled trials, according to conventions established for developing practice guidelines. BENEFITS AND COSTS: Certain forms of histoplasmosis cause life-threatening illnesses and result in considerable morbidity, whereas other manifestations cause no symptoms or minor self-limited illnesses. The nonprogressive forms of histoplasmosis, however, may reduce functional capacity, affecting work capacity and quality of life for several months. Treatment is clearly beneficial and cost-effective for patients with progressive forms of histoplasmosis, such as chronic pulmonary or disseminated infection. It remains unknown whether treatment improves the outcome for patients with the self-limited manifestations, since this patient population has not been studied. Other chronic progressive forms of histoplasmosis are not responsive to pharmacologic treatment.
Options for therapy for histoplasmosis include ketoconazole, itraconazole, fluconazole, amphotericin B (Fungizone; Bristol-Meyer Squibb, Princeton, NJ), liposomal amphotericin B (AmBisome; Fujisawa, Deerfield, IL), amphotericin B colloidal suspension (ABCD, or Amphotec; Seques, Menlo Park, CA), and amphotericin B lipid complex (ABLC, or Abelcet; Liposome, Princeton, NJ).
本指南的目的是为治疗组织胞浆菌病的常见类型患者提供建议。参与者与共识形成过程：召集了该领域的8位专家组成一个工作组来制定本指南。工作组通过一系列电话会议制定并完善了该指南。
治疗的目标是尽可能根除感染，不过对于艾滋病患者和其他严重免疫抑制性疾病患者，长期抑制治疗可能就足够了。其他重要结果包括临床异常情况的缓解和预防复发。
对已发表的关于组织胞浆菌病管理的文献进行了综述。已经开展了针对慢性肺组织胞浆菌病和播散性组织胞浆菌病治疗的对照试验，但临床经验和描述性研究为其他类型组织胞浆菌病的治疗建议提供了依据。价值：根据支持治疗建议的证据强度赋予相应价值，按照制定实践指南的惯例，对照试验被赋予最高价值。益处与成本：某些类型的组织胞浆菌病会导致危及生命的疾病，并造成相当大的发病率，而其他表现形式则不引起症状或仅导致轻微的自限性疾病。然而，非进行性的组织胞浆菌病形式可能会降低功能能力，影响数月的工作能力和生活质量。对于进行性形式的组织胞浆菌病患者，如慢性肺部或播散性感染患者，治疗显然是有益且具有成本效益的。对于自限性表现的患者，治疗是否能改善结局尚不清楚，因为尚未对这一患者群体进行研究。其他慢性进行性形式的组织胞浆菌病对药物治疗无反应。
组织胞浆菌病的治疗选择包括酮康唑、伊曲康唑、氟康唑、两性霉素B（Fungizone；百时美施贵宝公司，新泽西州普林斯顿）、脂质体两性霉素B（安必素；藤泽公司，伊利诺伊州迪尔菲尔德）、两性霉素B胶体悬浮液（ABCD，或安浮特克；Sequus公司，加利福尼亚州门洛帕克）以及两性霉素B脂质复合物（ABLC，或阿贝西；脂质体公司，新泽西州普林斯顿）。
