Minamoto G, Armstrong D
Infectious Disease Service, Memorial Sloan-Kettering Cancer Center, New York, New York.
Infect Dis Clin North Am. 1988 Jun;2(2):447-56.
Histoplasma capsulatum and Coccidioides immitis are two fungi that are regional in occurrence and cause opportunistic fungal infections in patients with AIDS. Many cases of histoplasmosis have been reported in patients months or years after they have been in an endemic area. These are obviously cases of reactivation of latent infections. With coccidioidomycosis, the cases have been reported from endemic areas, but some also appear to be reactivation infections, and we should anticipate such cases in nonendemic areas just as with histoplasmosis. The clinical presentations may be atypical, even mimicking acute bacterial sepsis. The diagnosis should be sought in any HIV-infected patient with an unexplained infection and residence or travel in an endemic area even in the remote past. Studies should include bone marrow examinations for histoplasmosis as well as skin biopsies with special strains and cultures for fungi for both infections. Sputum or bronchoscopy specimens have often been the source of a diagnosis in coccidioidomycosis. Serologic tests for antibody in both diseases yield inconsistently positive results in AIDS patients. Treatment of the acute infection should be with amphotericin B followed by maintenance suppressive therapy with ketoconazole or Amphotericin B.
荚膜组织胞浆菌和粗球孢子菌是两种具有地域局限性的真菌，可在艾滋病患者中引起机会性真菌感染。许多组织胞浆菌病病例报告于患者离开疫区数月或数年之后。这些显然是潜伏感染重新激活的病例。对于球孢子菌病，虽然病例多报告于疫区，但有些似乎也是潜伏感染的重新激活，而且与组织胞浆菌病一样，我们在非疫区也应留意此类病例。临床表现可能不典型，甚至类似急性细菌性败血症。对于任何有不明原因感染且曾在疫区居住或旅行（即使是很久以前）的HIV感染患者，均应进行诊断检查。检查应包括针对组织胞浆菌病的骨髓检查，以及针对这两种感染的采用特殊菌株和真菌培养的皮肤活检。痰液或支气管镜检查标本常常是球孢子菌病诊断的来源。这两种疾病的抗体血清学检测在艾滋病患者中结果不一，常呈阳性。急性感染的治疗应先用两性霉素B，随后用酮康唑或两性霉素B进行维持抑制治疗。
