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一例与HIV相关的播散性组织胞浆菌病的意大利病例。

An Italian Case of Disseminated Histoplasmosis Associated with HIV.

作者信息

Papalini Chiara, Belfiori Barbara, Martino Giovanni, Papili Rita, Pitzurra Lucia, Ascani Stefano, Pasticci Maria Bruna

机构信息

Infectious Diseases Clinic, Perugia University, S. Maria della Misericordia Hospital, Perugia 06132, Italy.

Hematology Clinic, Perugia University, S. Maria della Misericordia Hospital, Perugia 06132, Italy.

出版信息

Case Rep Infect Dis. 2019 Nov 16;2019:7403878. doi: 10.1155/2019/7403878. eCollection 2019.

DOI:10.1155/2019/7403878
PMID:31827952
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6885199/
Abstract

is a dimorphic fungus, endemic in the Americas, Africa (var. ), India, and Southeast Asia. infection is rarely diagnosed in Italy, while in Latin America, progressive disseminated histoplasmosis (PDH) is one of the most frequent AIDS-defining illnesses and causes of AIDS-related deaths. We report a case of PDH and new HIV infection diagnosis in a Cuban patient, who has been living in Italy for the past 10 years. Bone marrow aspirate and peripheral blood smear microscopy suggested infection. The diagnosis was confirmed with the culture method identifying its thermal dimorphism. Liposomal amphotericin B was administered alone for 10 days and then for another 2 days, accompanied with voriconazole; the former was stopped for probable side effects (persistent fever and worsening thrombocytopenia), and voriconazole was continued to complete 4 weeks. PDH maintenance treatment consisted of itraconazole for one year. Antiretroviral therapy (ART) was started on the third week of antifungal treatment. At the 3-year follow-up, the patient is adherent on ART, the virus was suppressed, and she has an optimal immune recovery. This case highlights the need to suspect histoplasmosis in the differential diagnosis of opportunistic infections in immunocompromised persons, native to or who have traveled to endemic countries.

摘要

是一种二态性真菌,在美洲、非洲(变种)、印度和东南亚地区流行。在意大利,组织胞浆菌病感染很少被诊断出来,而在拉丁美洲,播散性进行性组织胞浆菌病(PDH)是最常见的艾滋病界定疾病之一,也是艾滋病相关死亡的原因之一。我们报告了一例在意大利生活了10年的古巴患者被诊断出患有PDH和新发HIV感染的病例。骨髓穿刺和外周血涂片显微镜检查提示有组织胞浆菌感染。通过培养方法确定其热二态性,从而确诊。单独给予脂质体两性霉素B治疗10天,然后再联合伏立康唑治疗2天;由于可能的副作用(持续发热和血小板减少症恶化)停用了前者,继续使用伏立康唑完成4周治疗。PDH维持治疗包括使用伊曲康唑治疗一年。在抗真菌治疗的第三周开始抗逆转录病毒治疗(ART)。在3年的随访中,患者坚持接受ART治疗,病毒得到抑制,免疫功能得到了最佳恢复。该病例强调了在免疫功能低下的人群(无论其出生地或是否前往过流行国家)的机会性感染鉴别诊断中,需要怀疑组织胞浆菌病。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/59f3/6885199/ac14913f84de/CRIID2019-7403878.003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/59f3/6885199/d328a8a65612/CRIID2019-7403878.001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/59f3/6885199/0c3eb7e9a1f0/CRIID2019-7403878.002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/59f3/6885199/ac14913f84de/CRIID2019-7403878.003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/59f3/6885199/d328a8a65612/CRIID2019-7403878.001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/59f3/6885199/0c3eb7e9a1f0/CRIID2019-7403878.002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/59f3/6885199/ac14913f84de/CRIID2019-7403878.003.jpg

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