Thompson George R, Lewis James S, Nix David E, Patterson Thomas F
Department of Medical Microbiology and Immunology, University of California, Davis; Davis, California, USA.
Department of Internal Medicine, Division of Infectious Diseases, University of California Davis Medical Center; Sacramento, California, USA.
Med Mycol. 2019 Feb 1;57(Supplement_1):S76-S84. doi: 10.1093/mmy/myy029.
Coccidioidomycosis remains a significant clinical problem with substantial morbidity and mortality. The vast majority of infections are asymptomatic and the need for early primary therapy remains controversial. The use of triazole antifungals has improved tolerability of therapy but concerns about acute and long-term toxicities among available agents limit their use. In addition, recent findings of decreased in vitro fluconazole susceptibility to as many as 37% of Coccidioides spp. isolates raises concerns regarding optimal therapy for these infections as fluconazole is commonly used for therapy including central nervous system disease. Thus, new agents from novel antifungal classes are currently in preclinical and clinical development aimed at reducing toxicity and improving outcomes of these serious infections.
球孢子菌病仍然是一个严重的临床问题，具有较高的发病率和死亡率。绝大多数感染是无症状的，早期初级治疗的必要性仍存在争议。三唑类抗真菌药物的使用提高了治疗的耐受性，但现有药物的急性和长期毒性问题限制了它们的使用。此外，最近发现高达37%的球孢子菌属分离株对氟康唑的体外敏感性降低，这引发了对这些感染最佳治疗方案的担忧，因为氟康唑常用于包括中枢神经系统疾病在内的治疗。因此，新型抗真菌类别的新药目前正处于临床前和临床开发阶段，旨在降低毒性并改善这些严重感染的治疗效果。
