Schlossmacher P, Martinet O, Jaffar-Bandjee M C, Rivière M C, Gaüzère B A
Service de rdanimation polyvalente, CHR La Réunion, Centre hospitalier Félix Guyon, Saint-Denis, Réunion.
Med Trop (Mars). 2010 Aug;70(4):391-4.
The purpose of this report is to describe the first case of indigenous disseminated histoplasmosis caused by Histoplasma capsulatum in a patient on immunosuppression 22 months after renal transplantation in the Reunion Island. Involvement was predominantly pulmonary and outcome was rapidly fatal. Diagnosis based on isolation of characteristic intramacrophagic Histoplasma capsulatum yeast cells from bronchoalveolar fluid was delayed since indigenous cases of this opportunistic infection were unprecedented. In addition to demonstrating the difficulty of achieving diagnosis in places located outside endemic areas without modern facilities, this case underlines the potentially the poor prognosis of disseminated histoplasmosis. This disease should be included in differential diagnosis in the Reunion Island where many patients undergo immunosuppresion and receive organs shipped in from outside locations.
本报告旨在描述留尼汪岛一名肾移植术后22个月接受免疫抑制治疗的患者中，首例由荚膜组织胞浆菌引起的本地播散性组织胞浆菌病。病变主要累及肺部，病情迅速发展至致命。由于这种机会性感染的本地病例尚无先例，从支气管肺泡灌洗液中分离出特征性巨噬细胞内荚膜组织胞浆菌酵母细胞的诊断延迟。该病例不仅表明在没有现代设施的非流行地区进行诊断存在困难，还凸显了播散性组织胞浆菌病潜在的不良预后。在留尼汪岛，许多患者接受免疫抑制治疗并接受从外地运来的器官，因此该病应列入鉴别诊断范围。
