Pulmonary-Critical Care and Infectious Diseases, Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana 46202, USA.
Clin Infect Dis. 2010 Jan 1;50(1):85-92. doi: 10.1086/648724.
Life-threatening histoplasmosis is one of the most common opportunistic infections in patients receiving tumor necrosis factor (TNF) blockers. Delays in considering the diagnosis may lead to increased morbidity and mortality. Most affected patients present with pneumonitis, usually accompanied by additional signs of progressive dissemination, or with signs of progressive dissemination alone. The diagnosis often can be promptly established using antigen detection or direct examination of bronchoalveolar lavage specimens. If histoplasmosis is diagnosed promptly, antifungal therapy is highly effective. After a favorable clinical response, the safety of both discontinuation of antifungal therapy and the resumption of TNF blocker remains undetermined. The management of the immune reconstitution inflammatory syndrome that may follow discontinuation of TNF blockers also requires investigation. Prescribers should become aware of the recognition, diagnosis, and treatment of histoplasmosis and educate recipients about decreasing their risk of exposure and both recognizing and reporting signs of early infection.
危及生命的组织胞浆菌病是接受肿瘤坏死因子 (TNF) 阻滞剂治疗的患者中最常见的机会性感染之一。延迟考虑诊断可能会导致发病率和死亡率增加。大多数受影响的患者表现为肺炎，通常伴有进行性播散的其他迹象，或仅伴有进行性播散的迹象。使用抗原检测或直接检查支气管肺泡灌洗标本通常可以迅速确定诊断。如果及时诊断出组织胞浆菌病，抗真菌治疗非常有效。在临床反应良好后，停止抗真菌治疗和恢复 TNF 阻滞剂的安全性仍不确定。停用 TNF 阻滞剂后可能出现的免疫重建炎症综合征的治疗也需要研究。开处方者应了解组织胞浆菌病的识别、诊断和治疗，并教育接受者减少接触风险，以及识别和报告早期感染的迹象。
