Division of Infectious Diseases, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
Clin Infect Dis. 2010 Mar 15;50(6):797-804. doi: 10.1086/650579.
Central nervous system (CNS) involvement with Blastomyces dermatitidis is an uncommon and potentially fatal complication of blastomycosis.
We retrospectively reviewed 22 patients with CNS blastomycosis at our institutions from 1990 through 2008 (13 proven, 5 probable, and 4 possible cases).
Magnetic resonance imaging was used in most patients, alone or in addition to computed tomography. CNS blastomycosis manifested as epidural abscess (1 of 22), meningitis (7 of 22), intracranial mass lesions (10 of 22), and concomitant intracranial mass lesions and meningitis (4 of 22). All patients received amphotericin B deoxycholate or a lipid formulation of amphotericin B as part of their treatment regimens. Most patients received amphotericin B followed by a prolonged course of oral azole therapy (voriconazole, fluconazole, or itraconazole). Four (18%) of 22 patients died during follow-up.
On the basis of these data, we recommend initial treatment with a lipid formulation of amphotericin B followed by a prolonged course of oral azole therapy, preferably voriconazole.
中枢神经系统（CNS）累及皮炎芽生菌是芽生菌病的一种罕见且可能致命的并发症。
我们回顾性分析了 1990 年至 2008 年期间在我们机构中患有中枢神经系统芽生菌病的 22 名患者（13 例确诊，5 例可能，4 例疑似病例）。
大多数患者使用磁共振成像（MRI），单独或联合计算机断层扫描（CT）。中枢神经系统芽生菌病表现为硬膜外脓肿（22 例中的 1 例）、脑膜炎（22 例中的 7 例）、颅内肿块病变（22 例中的 10 例）和同时存在颅内肿块病变和脑膜炎（22 例中的 4 例）。所有患者均接受两性霉素 B 去氧胆酸盐或两性霉素 B 脂质体作为其治疗方案的一部分。大多数患者在接受两性霉素 B 治疗后，接受了长期的口服唑类药物治疗（伏立康唑、氟康唑或伊曲康唑）。22 名患者中有 4 名（18%）在随访期间死亡。
根据这些数据，我们建议初始治疗使用两性霉素 B 脂质体，然后进行长期口服唑类药物治疗，最好是伏立康唑。
