Division of Infectious Disease Therapeutics, Department of Microbiology and Infectious Diseases, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan.
J Infect Chemother. 2010 Dec;16(6):443-5. doi: 10.1007/s10156-010-0073-5. Epub 2010 Jun 12.
Histoplasmosis caused by Histoplasma capsulatum is found worldwide. Japan is known to be non-endemic area. Progressive disseminated histoplasmosis (PDH) is a severe form of histoplasmosis. We report a case of PDH in a 54-year-old male who was not immunocompromised. His last travel history to an endemic region was 2 years before onset. He was diagnosed as histoplasmosis by 18S rRNA-PCR from serum and ascites and immunodiffusion test. We treated him with parental liposomal amphotericin B for 2 weeks then changed to oral itraconazole, which was continued for 6 months. Rigorous work up, including HIV status, lymphocyte counts, and adrenal function did not reveal any evidence of immunosuppression of the patient. Our case suggests that PDH can occur in immunocompetent patients as previously described, and must be included in the differential diagnoses if presentation is consistent. In addition, the skills of travel history taking are emphasized.
组织胞浆菌病由荚膜组织胞浆菌引起，分布于世界各地。日本是非地方性流行区。播散性组织胞浆菌病（PDH）是组织胞浆菌病的严重形式。我们报告一例 54 岁男性 PDH 病例，该患者无免疫功能低下。他最近一次前往地方性流行地区是在发病前 2 年。通过血清和腹水的 18S rRNA-PCR 和免疫扩散试验诊断为组织胞浆菌病。我们给予患者两性霉素 B 脂质体 2 周治疗，然后改为口服伊曲康唑，持续 6 个月。对患者进行了包括 HIV 状态、淋巴细胞计数和肾上腺功能在内的严格检查，未发现任何免疫抑制的证据。我们的病例提示，PDH 可发生于先前描述的免疫功能正常的患者中，如果临床表现一致，则必须将其纳入鉴别诊断。此外，强调了旅行史采集的技巧。
