Azar Marwan M, Hage Chadi A
Pathology Department, Massachusetts General Hospital, Harvard School of Medicine, 55 Fruit Street, GRB 526, Boston, MA 02114, USA.
Thoracic Transplantation Program, Department of Medicine, Methodist Professional Center-2, Indiana University Health Methodist Hospital, Indiana University, Suite 2000, 1801 North Senate Boulevard, Indianapolis, IN 46202, USA.
Clin Chest Med. 2017 Sep;38(3):403-415. doi: 10.1016/j.ccm.2017.04.004. Epub 2017 May 17.
With increasing numbers of travelers and immunocompromised patients, histoplasmosis, caused by the dimorphic fungus Histoplasma capsulatum, has become a disease of national extent. The clinical spectrum of histoplasmosis is very wide, in terms of disease cadence, onset, distribution, and severity. A multipronged approach is recommended for diagnosis. Manifestations that are always treated include moderate to severe acute pulmonary histoplasmosis, disseminated disease, and histoplasmosis in immunocompromised individuals. Amphotericin B is the drug of choice for moderate to severe and disseminated presentations, whereas itraconazole is appropriate for mild disease and as step-down therapy.
随着旅行者和免疫功能低下患者数量的增加，由双相真菌荚膜组织胞浆菌引起的组织胞浆菌病已成为一种全国性的疾病。就疾病节奏、发病、分布和严重程度而言，组织胞浆菌病的临床谱非常广泛。建议采用多管齐下的方法进行诊断。始终需要治疗的表现包括中度至重度急性肺组织胞浆菌病、播散性疾病以及免疫功能低下个体的组织胞浆菌病。两性霉素B是中度至重度和播散性表现的首选药物，而伊曲康唑适用于轻度疾病和作为降阶梯治疗。
