非洲的组织胞浆菌病：一种新出现的还是被忽视的疾病？
Histoplasmosis in Africa: An emerging or a neglected disease?
机构信息
Department of Medical Microbiology and Parasitology, Faculty of Basic Medical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria.
Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom.
出版信息
PLoS Negl Trop Dis. 2018 Jan 18;12(1):e0006046. doi: 10.1371/journal.pntd.0006046. eCollection 2018 Jan.
Histoplasmosis in Africa has markedly increased since the advent of the HIV/AIDS epidemic but is under-recognised. Pulmonary histoplasmosis may be misdiagnosed as tuberculosis (TB). In the last six decades (1952-2017), 470 cases of histoplasmosis have been reported. HIV-infected patients accounted for 38% (178) of the cases. West Africa had the highest number of recorded cases with 179; the majority (162 cases) were caused by Histoplasma capsulatum var. dubuosii (Hcd). From the Southern African region, 150 cases have been reported, and the majority (119) were caused by H. capsulatum var. capsulatum (Hcc). There have been 12 histoplasmin skin test surveys with rates of 0% to 35% positivity. Most cases of Hcd presented as localised lesions in immunocompetent persons; however, it was disseminated in AIDS patients. Rapid diagnosis of histoplasmosis in Africa is only currently possible using microscopy; antigen testing and PCR are not available in most of Africa. Treatment requires amphotericin B and itraconazole, both of which are not licensed or available in several parts of Africa.
非洲的组织胞浆菌病自艾滋病流行以来显著增加，但未得到充分认识。肺组织胞浆菌病可能被误诊为结核病（TB）。在过去的六十年（1952-2017 年）中，已经报告了 470 例组织胞浆菌病。HIV 感染患者占病例的 38%（178 例）。西非记录的病例数最多，有 179 例；其中大多数（162 例）由荚膜组织胞浆菌变种杜波氏菌（Hcd）引起。来自南部非洲地区的报告有 150 例，其中大多数（119 例）由荚膜组织胞浆菌变种荚膜菌（Hcc）引起。已经进行了 12 次组织胞浆菌素皮肤试验调查，阳性率为 0%至 35%。大多数 Hcd 在免疫功能正常的人表现为局限性病变；然而，在 AIDS 患者中则是播散性的。目前在非洲，只有通过显微镜才能快速诊断组织胞浆菌病；抗原检测和 PCR 在非洲大部分地区都不可用。治疗需要使用两性霉素 B 和伊曲康唑，但这两种药物在非洲的几个地区都没有获得许可或供应。
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