Department of Internal Medicine, University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot #639, Little Rock, AR 72205, USA.
Clin Microbiol Rev. 2010 Apr;23(2):367-81. doi: 10.1128/CMR.00056-09.
Blastomycosis is endemic in regions of North America that border the Great Lakes and the St. Lawrence River, as well as in the Mississippi River and Ohio River basins. Men are affected more often than women and children because men are more likely to participate in activities that put them at risk for exposure to Blastomyces dermatitidis. Human infection occurs when soil containing microfoci of mycelia is disturbed and airborne conidia are inhaled. If natural defenses in the alveoli fail to contain the infection, lymphohematogenous dissemination ensues. Normal host responses generate a characteristic pyogranulomatous reaction. The most common sites of clinical disease are the lung and skin; osseous, genitourinary, and central nervous system manifestations follow in decreasing order of frequency. Blastomycosis is one of the great mimickers in medicine; verrucous cutaneous blastomycosis resembles malignancy, and mass-like lung opacities due to B. dermatitidis often are confused with cancer. Blastomycosis may be clinically indistinguishable from tuberculosis. Diagnosis is based on culture and direct visualization of round, multinucleated yeast forms that produce daughter cells from a single broad-based bud. Although a long course of amphotericin B is usually curative, itraconazole is also highly effective and is the mainstay of therapy for most patients with blastomycosis.
芽生菌病多见于毗邻五大湖和圣劳伦斯河的北美洲地区，以及密西西比河和俄亥俄河流域。男性比女性和儿童更容易患病，因为男性更有可能参与使他们接触皮炎芽生菌的活动。当含有菌丝微焦点的土壤受到干扰，空气中的分生孢子被吸入时，就会发生人类感染。如果肺泡中的天然防御无法控制感染，就会发生淋巴血液传播。正常的宿主反应会产生特征性的化脓性肉芽肿反应。最常见的临床疾病部位是肺部和皮肤；骨骼、泌尿生殖和中枢神经系统的表现则依次减少。芽生菌病是医学上的一大类模拟疾病；疣状皮肤芽生菌病类似于恶性肿瘤，而由皮炎芽生菌引起的块状肺部不透明影常与癌症相混淆。芽生菌病在临床上可能与结核病无法区分。诊断基于培养和直接观察圆形、多核酵母形态，这些酵母形态从单个宽基芽产生子细胞。尽管长期使用两性霉素 B 通常是有效的，但伊曲康唑也非常有效，是大多数芽生菌病患者的主要治疗方法。
