Ohno Hideaki, Ogata Yoshiko, Suguro Hajime, Yokota Soichiro, Watanabe Akira, Kamei Katsuhiko, Yamagoe Satoshi, Ishida-Okawara Akiko, Kaneko Yukihiro, Horino Atsuko, Yamane Kunikazu, Tsuji Takahiro, Nagata Noriyo, Hasegawa Hideki, Arakawa Yoshichika, Sata Tetsutaro, Miyazaki Yoshitsugu
Department of Chemotherapy and Mycoses, National Institute of Infectious Diseases, Tokyo.
Intern Med. 2010;49(5):491-5. doi: 10.2169/internalmedicine.49.2759. Epub 2010 Mar 1.
Histoplasmosis, caused by Histoplasma capsulatum, is an endemic mycosis in many countries of the world except for Japan. Outbreaks of histoplasmosis among Japanese people are very rare and are mainly imported by travelers. We report an outbreak of histoplasmosis among healthy Japanese people who traveled to a resort area in Southeast Asia. Three young Japanese women traveled to Langkawi island, Malaysia and stayed on the island for five days without visiting caves, a known reservoir of H. capsulatum. All three individuals developed flu-like symptoms with multiple nodule shadows on chest X rays or chest CT scans at around ten days after their return to Japan. Serum samples obtained from the three subjects were positive for anti-Histoplasma antibody and specific PCR for H. capsulatum on lung biopsy specimens and the serum from one patient was positive. The clinical course of all three patients improved without the use of anti-fungal agents and no recurrence has been confirmed. Clinical attendants should consider histoplasmosis when they see patients with flu-like symptoms with abnormal chest X-rays after visiting H. capsulatum endemic areas, especially Southeast Asia.
由荚膜组织胞浆菌引起的组织胞浆菌病是世界上除日本外许多国家的地方性真菌病。日本人中组织胞浆菌病的暴发非常罕见，主要由旅行者输入。我们报告了一起发生在前往东南亚度假区旅行的健康日本人中的组织胞浆菌病暴发。三名年轻日本女性前往马来西亚兰卡威岛，在岛上停留了五天，未参观洞穴（已知的荚膜组织胞浆菌储存地）。三人返回日本后约十天，均出现类似流感的症状，胸部X光或胸部CT扫描显示有多个结节阴影。从三名受试者采集的血清样本抗组织胞浆菌抗体呈阳性，肺活检标本的荚膜组织胞浆菌特异性PCR检测以及其中一名患者的血清检测呈阳性。三名患者的临床病程在未使用抗真菌药物的情况下有所改善，且未确认有复发情况。临床医护人员在诊治前往荚膜组织胞浆菌流行地区（尤其是东南亚）旅行后出现类似流感症状且胸部X光异常的患者时，应考虑组织胞浆菌病。
