Caceres Diego H, Valdes Audrey
Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
Studies in Translational Microbiology and Emerging Diseases (MICROS) Research Group, School of Medicine and Health Sciences, Universidad del Rosario, 11011 Bogota, Colombia.
J Fungi (Basel). 2019 Aug 9;5(3):73. doi: 10.3390/jof5030073.
Distinguishing between histoplasmosis, tuberculosis (TB), and co-occurrence of disease is a frequent dilemma for clinical staff treating people with advanced Human Immunodeficiency Virus (HIV) infection. This problem is most frequently observed in clinical settings in countries where both diseases are endemic. It is also a challenge outside these endemic countries in HIV clinics that take care of patients coming from countries with endemic histoplasmosis and TB. The gold standard for diagnosis of both of these diseases is based on conventional laboratory tests (culture, histopathology and special stains). These tests have several limitations, such as lack of laboratory infrastructure for handling isolates (biosafety level 3), shortage of laboratory staff who have appropriate training and experience, variable analytical performance of tests and long turn-around time. Recently, novel rapid assays for the diagnosis of histoplasmosis and TB became available. However, this technology is not yet widely used. Mortality in immunocompromised patients, such as people with advanced HIV, is directly linked with the ability to rapidly diagnose opportunistic diseases. The aim of this review is to synthesize the main aspects of epidemiology, clinical characteristics, diagnosis and treatment of histoplasmosis/TB co-occurrence in people with advanced HIV.
对于治疗晚期人类免疫缺陷病毒（HIV）感染者的临床工作人员而言，区分组织胞浆菌病、结核病（TB）以及这两种疾病的合并感染情况常常是个难题。在这两种疾病均为地方病的国家，这种问题在临床环境中最为常见。在照顾来自组织胞浆菌病和结核病流行国家患者的HIV诊所中，即便在这些非流行国家，这也是一项挑战。这两种疾病诊断的金标准基于传统实验室检测（培养、组织病理学和特殊染色）。这些检测存在若干局限性，例如缺乏处理分离株的实验室基础设施（生物安全3级）、缺乏经过适当培训和有经验的实验室工作人员、检测的分析性能各异以及周转时间长。最近，出现了用于诊断组织胞浆菌病和结核病的新型快速检测方法。然而，这项技术尚未得到广泛应用。免疫功能低下患者（如晚期HIV感染者）的死亡率与快速诊断机会性疾病的能力直接相关。本综述的目的是综合晚期HIV感染者中组织胞浆菌病/结核病合并感染的流行病学、临床特征、诊断和治疗的主要方面。
