Bradsher R W
Division of Infectious Diseases, University of Arkansas for Medical Sciences, Little Rock 72205.
Semin Respir Infect. 1990 Jun;5(2):105-10.
Three additions to the understanding of blastomycosis have been noted over the past several years. First, Blastomyces dermatitidis has now been grown from soil in association with epidemics of infection, indicating that microfoci of the organism exist in nature. Second, immune markers of previous infections have been used to help confirm that subclinical or asymptomatic cases occur in endemic areas. This is well recognized for other fungal infections, like histoplasmosis, and is increasingly recognized for blastomycosis. Third, alternatives to amphotericin B have been discovered effectively to treat clinical blastomycosis. Ketoconazole and itraconazole, which are orally absorbed imidazole antifungal agents, have been shown to be impressive antibiotics for blastomycosis that is less than life-threatening. Amphotericin B remains the agent of choice to treat patients with central nervous system or overwhelming blastomycosis.
在过去几年中，人们对芽生菌病的认识有了三点新进展。首先，皮炎芽生菌现已从与感染流行相关的土壤中培养出来，这表明该生物体在自然界中存在微小病灶。其次，既往感染的免疫标志物已被用于帮助确认在流行地区存在亚临床或无症状病例。这在其他真菌感染（如组织胞浆菌病）中已得到充分认识，在芽生菌病中也越来越受到认可。第三，已发现两性霉素B的替代药物可有效治疗临床芽生菌病。酮康唑和伊曲康唑是口服吸收的咪唑类抗真菌药物，已被证明是治疗非危及生命的芽生菌病的有效抗生素。两性霉素B仍然是治疗中枢神经系统或严重芽生菌病患者的首选药物。
