Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany.
German Center for Infection Research, Clinical Tuberculosis Center, Borstel, Germany.
Respiration. 2018;96(3):283-301. doi: 10.1159/000489501. Epub 2018 Jun 28.
Systemic endemic mycoses cause high rates of morbidity and mortality in certain regions of the world and the real impact on global health is not well understood. Diagnosis and management remain challenging, especially in low-prevalence settings, where disease awareness is lacking. The main challenges include the variability of clinical presentation, the fastidious and slow-growing nature of the fungal pathogens, the paucity of diagnostic tests, and the lack of options and toxicity of antifungal drugs. Coccidioidomycosis and paracoccidioidomycosis are restricted to the Americas only, and while histoplasmosis and blastomycosis also occur predominantly in the Americas, these mycoses have also been reported on other continents, especially in sub-Saharan Africa. Talaromycosis is endemic in tropical and subtropical regions in South-East Asia and southern China. Systemic endemic mycoses causing pulmonary disease are usually acquired via the airborne route by inhalation of fungal spores. Infections can range from asymptomatic or mild with flu-like illnesses to severe pulmonary or disseminated diseases. Skin involvement is frequent in patients with paracoccidioidomycosis, blastomycosis, sporotrichosis, and talaromycosis and manifests as localized lesions or diffuse nodules in disseminated disease, but can also occur with other endemic mycoses. Culture and/or characteristic histopathology from clinical samples is the diagnostic standard for endemic mycoses. Immunological assays are often not available for the diagnosis of most endemic mycoses and molecular amplification methods for the detection of fungal nucleic acids are not standardized at present. The first-line treatment for mild to moderate histoplasmosis, paracoccidioidomycosis, blastomycosis, sporotrichosis, and talaromycosis is itraconazole. Severe illness is treated with amphotericin B. Patients with severe coccidioidomycosis should receive fluconazole. Treatment duration depends on the specific endemic mycosis, the severity of disease, and the immune status of the patient, ranging between 6 weeks and lifelong treatment.
系统性地方性真菌病在世界某些地区导致高发病率和死亡率，但其对全球健康的实际影响尚未得到充分认识。诊断和管理仍然具有挑战性，尤其是在疾病意识缺乏的低流行地区。主要挑战包括临床表现的多样性、真菌病原体的苛刻和缓慢生长特性、诊断测试的缺乏以及抗真菌药物的选择有限和毒性。球孢子菌病和副球孢子菌病仅局限于美洲，而组织胞浆菌病和芽生菌病也主要发生在美洲，但这些真菌病也在其他大洲报告过，尤其是在撒哈拉以南非洲。粗球孢子菌病流行于东南亚和中国南部的热带和亚热带地区。引起肺部疾病的系统性地方性真菌病通常通过吸入真菌孢子的空气传播途径获得。感染可从无症状或类似流感样轻度疾病到严重肺部或播散性疾病不等。皮肤受累在副球孢子菌病、芽生菌病、孢子丝菌病和粗球孢子菌病患者中很常见，表现为局限性病变或播散性疾病中的弥漫性结节，但也可能发生于其他地方性真菌病。从临床样本中进行培养和/或特征性组织病理学检查是地方性真菌病的诊断标准。大多数地方性真菌病的诊断通常无法进行免疫测定，目前用于检测真菌核酸的分子扩增方法也没有标准化。轻度至中度组织胞浆菌病、副球孢子菌病、芽生菌病、孢子丝菌病和粗球孢子菌病的一线治疗药物是伊曲康唑。严重疾病采用两性霉素 B 治疗。严重的球孢子菌病患者应使用氟康唑。治疗持续时间取决于具体的地方性真菌病、疾病严重程度以及患者的免疫状态，范围从 6 周至终身治疗不等。
