Hedges E, Miller S
Good Samaritan Regional Medical Center, Phoenix, Arizona.
Am Fam Physician. 1990 May;41(5):1499-506.
Although most patients with coccidioidomycosis are asymptomatic, up to 40 percent develop fatigue, cough, chest pain and fever. Erythema nodosum is often present. Chest radiographs may be normal or may show hilar adenopathy, infiltrates, pulmonary nodules or thin-walled cavities. The spherulin skin test is usually positive within three weeks of infection. Specific IgM [corrected] antibodies may be detected early in the course; IgG [corrected] antibodies develop after two to three months. In most patients, the disease has a self-limited course and requires no specific therapy. A few patients develop progressive pulmonary or disseminated disease. Extrapulmonary sites of disease include the skin, the skeleton and, rarely, the nervous system. Amphotericin B and ketoconazole are used to treat disseminated disease. Because coccidioidomycosis is caused by a fungus that is endemic in the Southwest, a travel history should be elicited from patients with persistent pulmonary symptoms.
虽然大多数球孢子菌病患者没有症状，但高达40%的患者会出现疲劳、咳嗽、胸痛和发热。常出现结节性红斑。胸部X线片可能正常，也可能显示肺门淋巴结肿大、浸润、肺结节或薄壁空洞。球孢子菌素皮肤试验通常在感染后三周内呈阳性。病程早期可检测到特异性IgM抗体；IgG抗体在两到三个月后出现。大多数患者的疾病呈自限性，无需特殊治疗。少数患者会发展为进行性肺部疾病或播散性疾病。肺外疾病部位包括皮肤、骨骼，很少累及神经系统。两性霉素B和酮康唑用于治疗播散性疾病。由于球孢子菌病由一种在西南部流行的真菌引起，对于有持续肺部症状的患者应询问旅行史。
