Pappas P G, Pottage J C, Powderly W G, Fraser V J, Stratton C W, McKenzie S, Tapper M L, Chmel H, Bonebrake F C, Blum R
University of Alabama, School of Medicine, Birmingham.
Ann Intern Med. 1992 May 15;116(10):847-53. doi: 10.7326/0003-4819-116-10-847.
To describe the clinical, demographic, radiographic, diagnostic, and therapeutic aspects of blastomycosis in patients with the acquired immunodeficiency syndrome (AIDS).
A retrospective survey.
Ten university medical centers and community hospitals, six in geographic areas endemic for Blastomyces dermatitidis, and four outside the endemic area.
We identified 15 patients with blastomycosis and positive serologic test results for human immunodeficiency virus (HIV).
A diagnosis of blastomycosis was based on a positive culture (14 patients) or typical histopathologic features (one patient) for B. dermatitidis in clinical specimens.
Twelve of 15 patients had a previous or concomitant AIDS-defining illness at the time of diagnosis of blastomycosis, and only one patient had a CD4 lymphocyte count of greater than 200 cells/mm3. Two patterns of disease emerged: localized pulmonary involvement (seven patients), and disseminated or extrapulmonary blastomycosis (eight patients). Central nervous system involvement was common (40%). Six patients died within 21 days of presentation with blastomycosis, including four patients with disseminated and two with fulminant pulmonary disease. Among the nine patients who survived longer than 1 month, all received amphotericin B as initial antifungal therapy, and most received subsequent therapy with ketoconazole. Only two of these nine patients died with evidence of progressive blastomycosis.
Blastomycosis is a late and frequently fatal infectious complication in a few patients with AIDS. In these patients, overwhelming disseminated disease including involvement of the central nervous system is common, and it is associated with a high early mortality. Initial therapy with amphotericin B is appropriate in patients with AIDS and presumptive blastomycosis.
描述获得性免疫缺陷综合征（AIDS）患者芽生菌病的临床、人口统计学、影像学、诊断及治疗方面的情况。
一项回顾性调查。
十所大学医学中心和社区医院，其中六所在皮炎芽生菌的地方性流行区域，四所在非流行区域。
我们确定了15例芽生菌病患者，其血清学检测结果显示人类免疫缺陷病毒（HIV）呈阳性。
芽生菌病的诊断基于临床标本中皮炎芽生菌培养阳性（14例患者）或典型组织病理学特征（1例患者）。
15例患者中有12例在诊断芽生菌病时患有先前或同时存在的AIDS定义疾病，只有1例患者的CD4淋巴细胞计数大于200个细胞/mm³。出现了两种疾病模式：局限性肺部受累（7例患者）和播散性或肺外芽生菌病（8例患者）。中枢神经系统受累很常见（40%）。6例患者在出现芽生菌病症状后21天内死亡，包括4例播散性疾病患者和2例暴发性肺部疾病患者。在存活超过1个月的9例患者中，所有患者均接受两性霉素B作为初始抗真菌治疗，大多数患者随后接受酮康唑治疗。这9例患者中只有2例死于进展性芽生菌病。
芽生菌病是少数AIDS患者中晚期且常致命的感染性并发症。在这些患者中，包括中枢神经系统受累的严重播散性疾病很常见，且与早期高死亡率相关。对于患有AIDS且疑似芽生菌病的患者，初始治疗使用两性霉素B是合适的。
