Lung Institute of Western Australia and Centre for Asthma, Allergy and Respiratory Research, University of Western Australia, Perth, Australia.
Med Mycol. 2013 Jul;51(5):534-44. doi: 10.3109/13693786.2012.751643. Epub 2013 Jan 4.
Pulmonary infections by Sporothrix spp. manifest radiologically as cavitary or non-cavitary disease depending on whether the infection is primary pulmonary or multifocal sporotrichosis. Despite current guidelines, the optimal management for pulmonary sporotrichosis remains unclear. In order to clarify this, we present two cases of pulmonary sporotrichosis, as well as the results of a comprehensive literature review of treatment outcomes based on clinico-radiological presentation patterns of the disease. A literature search of all case reports in English language over the last 50 years (1960-2010) was conducted. Data on patient characteristics, risk factors, clinico-radiological patterns, treatment modalities and outcomes were collected and analyzed. A total of 86 cases were identified, i.e., 64 (74.4%) primary pulmonary and 22 (25.6%) multifocal sporotrichosis. Radiologically, primary pulmonary disease was commonly characterized by cavity formation which was lacking in multifocal infections (P = 0.0001). Immunosuppressant use was more common in multifocal sporotrichosis (P = 0.0001), while hemoptysis was more common in primary pulmonary form (P = 0.01). No other differences in patient characteristics or risk factors were noted. Extra-pulmonary multifocal sporotrichosis most commonly involved skin (81.8%) and joints (45.4%). For patients with cavitary primary pulmonary sporotrichosis, outcomes from medical therapy alone were inferior to surgical intervention (P = 0.02). However, for both primary pulmonary and multifocal sporotrichosis with non-cavitary disease, medical therapy alone provided good outcomes. Only 12 (16.7%) cases were treated with itraconazole. Treatment of pulmonary sporotrichosis should be guided by the clinico-radiological patterns of presentation. Medical therapy alone is likely sufficient for non-cavitary disease while early surgery should be considered for cavitary primary pulmonary sporotrichosis. The experience in treating cavitary disease with itraconazole alone is limited and further data are required.
葡聚糖菌属引起的肺部感染在影像学上表现为空洞性或非空洞性疾病，具体取决于感染是原发性肺部感染还是多发性播散性孢子丝菌病。尽管有现行指南，但肺部孢子丝菌病的最佳治疗方法仍不清楚。为了阐明这一点，我们报告了两例肺部孢子丝菌病，并对基于疾病临床放射学表现模式的治疗结果进行了全面的文献回顾。对过去 50 年（1960 年至 2010 年）所有英文病例报告进行了文献检索。收集并分析了患者特征、危险因素、临床放射学模式、治疗方式和结果的数据。共确定了 86 例病例，即 64 例（74.4%）原发性肺部和 22 例（25.6%）多发性孢子丝菌病。放射学上，原发性肺部疾病通常表现为空洞形成，而多发性感染则无空洞形成（P=0.0001）。免疫抑制剂的使用在多发性孢子丝菌病中更为常见（P=0.0001），而咯血在原发性肺部形式中更为常见（P=0.01）。未观察到患者特征或危险因素的其他差异。肺部以外的多发性孢子丝菌病最常累及皮肤（81.8%）和关节（45.4%）。对于有空洞的原发性肺部孢子丝菌病患者，单独药物治疗的结果不如手术干预（P=0.02）。然而，对于有空洞和无空洞的原发性肺部和多发性孢子丝菌病，单独药物治疗可获得良好的结果。仅 12 例（16.7%）接受了伊曲康唑治疗。肺部孢子丝菌病的治疗应根据临床表现和放射学模式进行指导。单独药物治疗可能足以治疗无空洞性疾病，而对于有空洞的原发性肺部孢子丝菌病，应早期考虑手术。单独使用伊曲康唑治疗空洞性疾病的经验有限，需要进一步的数据。
