Vaaler A K, Bradsher R W, Davies S F
Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota 55415.
Am J Med. 1990 Oct;89(4):470-6. doi: 10.1016/0002-9343(90)90378-q.
To investigate the incidence of remote subclinical blastomycosis in a high-risk population of forestry workers.
The study consisted of 39 male forestry workers from northern Minnesota and northern Wisconsin, areas endemic for blastomycosis but not for histoplasmosis. All subjects were histoplasmin skin test-negative, and none had ever been diagnosed with blastomycosis or pneumonia. An antigen-specific lymphocyte stimulation assay was performed to determine the presence of blastomycosis.
Peripheral blood lymphocytes from 12 of 39 subjects demonstrated specific antigen-induced proliferation when stimulated with a purified alkali- and water-soluble antigen derived from the cell wall of Blastomyces dermatitidis.
The finding that 30% of these men had evidence of previous blastomycosis suggests that subclinical cases do occur sporadically, and are probably more common than diagnosed symptomatic cases. This is similar to histoplasmosis, in which the majority of infections are subclinical. However, the reservoir of persons with previous undiagnosed blastomycosis is probably small compared to the huge number of persons (perhaps 30 million) with prior histoplasmosis.
调查林业工人高危人群中远距离亚临床芽生菌病的发病率。
该研究包括39名来自明尼苏达州北部和威斯康星州北部的男性林业工人，这些地区是芽生菌病的流行地区，但不是组织胞浆菌病的流行地区。所有受试者组织胞浆菌素皮肤试验均为阴性，且均未被诊断患有芽生菌病或肺炎。进行了抗原特异性淋巴细胞刺激试验以确定是否存在芽生菌病。
当用从皮炎芽生菌细胞壁提取的纯化碱溶性和水溶性抗原刺激时，39名受试者中有12名的外周血淋巴细胞表现出特异性抗原诱导的增殖。
这些男性中有30%有既往芽生菌病证据的这一发现表明，亚临床病例确实偶尔发生，而且可能比已诊断的有症状病例更为常见。这与组织胞浆菌病类似，其中大多数感染是亚临床的。然而，与大量（可能3000万）既往患有组织胞浆菌病的人相比，既往未诊断出芽生菌病的人群可能较少。
