Michael Saccente, MD Department of Medicine and Division of Infectious Diseases, University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot 639, Little Rock, AR 72205, USA.
Curr Treat Options Neurol. 2008 May;10(3):161-7. doi: 10.1007/s11940-008-0017-x.
Involvement of the central nervous system (CNS) is recognized clinically in 5% to 10% of patients with progressive disseminated histoplasmosis. The risk of developing CNS histoplasmosis is increased in individuals with impaired cellular immunity, but not all patients with this condition are immunocompromised. Clinical syndromes include chronic meningitis, focal parenchymal lesions of the brain or spinal cord, stroke due to infected emboli, and diffuse encephalitis. CNS histoplasmosis should be considered in any patient with one of these syndromes who has resided in an area endemic for histoplasmosis. A high index of suspicion is necessary when extraneural signs and symptoms are absent. Culture of the causative fungus, Histoplasma capsulatum, from cerebrospinal fluid, brain tissue, or other sites is the gold standard for diagnosis. In culture-negative cases, detection of H. capsulatum antigen in cerebrospinal fluid, urine, or blood is helpful diagnostically. Aggressive and prolonged antifungal therapy is indicated in all cases of CNS histoplasmosis. There are no data from prospective comparative trials upon which to base specific recommendations for treatment. Expert opinion favors an initial course of liposomal amphotericin B, followed by at least 1 year of itraconazole.
中枢神经系统（CNS）受累在进展性播散性组织胞浆菌病患者中临床可见于 5%至 10%。细胞免疫受损的个体发生中枢神经系统组织胞浆菌病的风险增加，但并非所有此类患者均存在免疫功能低下。临床综合征包括慢性脑膜炎、脑或脊髓局灶性实质病变、感染性栓子引起的中风和弥漫性脑炎。对于居住在组织胞浆菌病流行地区且具有上述综合征之一的任何患者，均应考虑中枢神经系统组织胞浆菌病。当无神经外表现和症状时，需要高度怀疑。从脑脊液、脑组织或其他部位培养出病原体荚膜组织胞浆菌是诊断的金标准。在培养阴性的情况下，检测脑脊液、尿液或血液中的荚膜组织胞浆菌抗原有助于诊断。所有中枢神经系统组织胞浆菌病均应采用积极和长期的抗真菌治疗。尚无前瞻性比较试验的数据可据此为治疗提供具体建议。专家意见倾向于初始采用脂质体两性霉素 B 治疗，然后至少使用伊曲康唑治疗 1 年。
