Infectious Disease Associates of Kansas City, Kansas City, Missouri, USA.
Semin Respir Crit Care Med. 2011 Dec;32(6):735-44. doi: 10.1055/s-0031-1295721. Epub 2011 Dec 13.
Pulmonary histoplasmosis is an important cause of morbidity in the United States. Several outbreaks of acute pulmonary histoplasmosis have been linked to potentially preventable environmental exposures. Progressive disseminated histoplasmosis, which is seen frequently in the growing population of immunocompromised hosts, often presents with prominent pulmonary manifestations and is more commonly encountered in hospitalized patients than acute, subacute, or chronic pulmonary histoplasmosis. A battery of diagnostic studies including serology, antigen, cytology/histopathology, and culture should be obtained in suspected cases of histoplasmosis. The yield of antigenuria detection is highest when the multiple body fluids are tested; the level of antigenuria correlates with severity of disease. Amphotericin B is the treatment of choice for severe pulmonary or disseminated histoplasmosis, and itraconazole is effective for mild to moderately severe infection. Posaconazole exhibits promise as a salvage agent. Antifungal prophylaxis is not routinely recommended for at-risk populations. Measures to minimize environmental contamination may reduce the risk of epidemic-type acute pulmonary histoplasmosis related to high-risk exposures.
肺组织胞浆菌病是美国发病率的一个重要原因。有几起因潜在可预防的环境暴露而导致的急性肺组织胞浆菌病暴发。广泛播散性组织胞浆菌病在免疫功能低下宿主的不断增加的人群中经常见到，常表现为明显的肺部表现，在住院患者中比急性、亚急性或慢性肺组织胞浆菌病更为常见。在疑似组织胞浆菌病的病例中，应获得一系列包括血清学、抗原、细胞学/组织病理学和培养在内的诊断研究。当检测多种体液时，尿抗原检测的阳性率最高；尿抗原水平与疾病严重程度相关。两性霉素 B 是治疗严重肺部或播散性组织胞浆菌病的首选药物，伊曲康唑对轻度至中度严重感染有效。泊沙康唑作为一种挽救药物显示出前景。对于高危人群，不常规推荐抗真菌预防。减少环境污染的措施可能会降低与高危暴露相关的流行型急性肺组织胞浆菌病的风险。
