Bernstein Stacey, Brunner Hermine I, Summerbell Richard, Allen Upton, Babyn Paul, Richardson Susan E
Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario.
Can J Infect Dis. 2002 Jul;13(4):259-63. doi: 10.1155/2002/906757.
Three paediatric cases of blastomycosis, apparently acquired in or near Toronto, Ontario, a region not known to be endemic for this disease, are described. Blastomycosis was not suspected clinically in any of the three cases, and the diagnosis was established only when the diagnostic net was broadened to include fungal and mycobacterial cultures. All three patients were diagnosed after significant delays, which is consistent with the rarity of the disease in children and its acquisition outside previously accepted geographical boundaries. Pulmonary involvement was present in all three children, while one also had multifocal osteomyelitis. Drug therapy was successful in all three cases, either with amphotericin B followed by itraconazole, or itraconazole alone. Blastomycosis should be included in the differential diagnosis of a patient from the Toronto area who presents with a compatible history despite a negative travel history to known endemic zones.
本文描述了三例芽生菌病儿科病例，这些病例显然是在安大略省多伦多市或其附近感染的，而该地区并非已知的芽生菌病流行区。这三例病例临床上均未怀疑患有芽生菌病，仅在扩大诊断范围以包括真菌和分枝杆菌培养时才确诊。所有三名患者均在出现明显延误后才被诊断，这与该病在儿童中罕见且在先前公认的地理边界之外感染的情况相符。所有三名儿童均有肺部受累，其中一名还患有多灶性骨髓炎。三例病例药物治疗均成功，要么先用两性霉素B然后用伊曲康唑，要么单用伊曲康唑。对于来自多伦多地区且有相关病史但前往已知流行区旅行史为阴性的患者，鉴别诊断应包括芽生菌病。
