Valley Fever Center for Excellence, University of Arizona College of Medicine-Tucson, Tucson, Arizona, USA.
Department of Medicine, University of Arizona College of Medicine-Tucson, Tucson, Arizona, USA.
Clin Infect Dis. 2020 Apr 15;70(9):2008-2012. doi: 10.1093/cid/ciz933.
The care of primary pulmonary coccidioidomycosis remains challenging. Such infections produce a variety of signs, symptoms, and serologic responses that cause morbidity in patients and concern in treating clinicians for the possibility of extrapulmonary dissemination. Illness may be due to ongoing fungal growth that produces acute inflammatory responses, resulting in tissue damage and necrosis, and for this, administering an antifungal drug may be of benefit. In contrast, convalescence may be prolonged by other immunologic reactions to infection, even after fungal replication has been arrested, and in those situations, antifungal therapy is unlikely to yield clinical improvement. In this presentation, we discuss what findings are clinical indicators of fungal growth and what other sequelae are not. Understanding these differences provides a rational management strategy for deciding when to continue, discontinue, or reinstitute antifungal treatments.
原发性肺球孢子菌病的治疗仍然具有挑战性。此类感染可产生多种体征、症状和血清学反应，导致患者发病和治疗医生担心可能发生肺外播散。疾病可能是由于真菌持续生长引起急性炎症反应，导致组织损伤和坏死，因此，使用抗真菌药物可能有益。相比之下，即使在真菌复制被阻止后，其他免疫反应也可能导致恢复期延长，在这种情况下，抗真菌治疗不太可能改善临床症状。在本次演讲中，我们将讨论哪些发现是真菌生长的临床指标，哪些其他后果不是。了解这些差异为决定何时继续、停止或重新开始抗真菌治疗提供了合理的管理策略。
