Global Action Fund for Fungal Infections, Geneva, Switzerland; The National Aspergillosis Centre, University Hospital of South Manchester, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
Department of Medical Microbiology, Postgraduate Institute of Medical Education & Research, Chandigarh, India.
Lancet Infect Dis. 2017 Nov;17(11):e357-e366. doi: 10.1016/S1473-3099(17)30309-2. Epub 2017 Jul 31.
The human respiratory tract is exposed daily to airborne fungi, fungal enzymes, and secondary metabolites. The endemic fungi Histoplasma capsulatum, Coccidioides spp, Blastomyces dermatitidis, and Paracoccidioides brasiliensis, and occasionally Aspergillus fumigatus, are primary pulmonary pathogens of otherwise healthy people. Such infections resolve in most people, and only a few infections lead to disease. However, many fungi are directly allergenic by colonising the respiratory tract or indirectly through contact with cell wall constituents and proteases, causing or exacerbating allergic disease. Increasing evidence implicates high indoor fungal exposures as a precipitant of asthma in children and in worsening asthma symptoms. Lung or airways infection by endemic fungi or aspergillus can be diagnosed with respiratory sample culture or serum IgG testing. Sputum, induced sputum, or bronchial specimens are all suitable specimens for detecting fungi; microscopy, fungal culture, galactomannan antigen, and aspergillus PCR are useful tests. Antifungal treatment is indicated in almost all patients with chronic cavitary pulmonary infections, chronic invasive and granulomatous rhinosinusitis, and aspergillus bronchitis. Most patients with fungal asthma benefit from antifungal therapy. Adverse reactions to oral azoles, drug interactions, and azole resistance in Aspergillus spp limit therapy. Environmental exposures, genetic factors, and structural pulmonary risk factors probably underlie disease but are poorly understood.
人的呼吸道每天都会接触到空气中的真菌、真菌酶和次级代谢物。荚膜组织胞浆菌、粗球孢子菌、皮炎芽生菌和巴西副球孢子菌，以及偶尔的烟曲霉，是健康人群原发性肺部病原体。这些感染在大多数人中会自行消退，只有少数感染会导致疾病。然而，许多真菌通过定植呼吸道或通过接触细胞壁成分和蛋白酶而直接致敏，导致或加重过敏性疾病。越来越多的证据表明，室内真菌暴露过高是儿童哮喘发作和哮喘症状恶化的一个诱因。通过呼吸道样本培养或血清 IgG 检测可诊断地方性真菌或曲霉菌引起的肺部或气道感染。痰液、诱导痰或支气管标本均适合用于检测真菌；显微镜检查、真菌培养、半乳甘露聚糖抗原和曲霉 PCR 是有用的检测方法。几乎所有慢性空洞性肺部感染、慢性侵袭性和肉芽肿性鼻旁窦炎以及曲霉性支气管炎患者都需要进行抗真菌治疗。大多数真菌性哮喘患者都能从抗真菌治疗中获益。口服唑类药物的不良反应、药物相互作用以及曲霉菌的唑类耐药性限制了治疗。环境暴露、遗传因素和结构性肺部危险因素可能是疾病的基础，但了解甚少。
