Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut.
Vanderbilt University School of Medicine, Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Nashville, Tennessee.
Semin Respir Crit Care Med. 2020 Feb;41(1):13-30. doi: 10.1055/s-0039-1698429. Epub 2020 Jan 30.
Histoplasmosis is a global disease endemic to regions of all six inhabited continents. The areas of highest endemicity lie within the Mississippi and Ohio River Valleys of North America and parts of Central and South America. As a result of climate change and anthropogenic land utilization, the conditions suitable for are changing, leading to a corresponding change in epidemiology. The clinical manifestations of histoplasmosis are protean, variably resembling other common conditions such as community-acquired pneumonia, tuberculosis, sarcoidosis, Crohn's disease, or malignancy. Making a successful diagnosis is contingent on a thorough understanding of epidemiology, common clinical presentations, and best testing practices for histoplasmosis. While most subclinical or self-limited diseases do not require treatment in immunocompetent patients, all immunocompromised patients and those with progressive disseminated disease or chronic pulmonary disease should be treated. Liposomal amphotericin B is the preferred agent for severe or disseminated disease, while itraconazole is adequate for milder cases and "step-down" therapy following response to amphotericin B. In this review, we discuss the current evidence-based approaches to the epidemiology, diagnosis, and management of histoplasmosis.
组织胞浆菌病是一种全球性疾病，流行于六大洲所有有人居住的地区。高流行地区位于北美洲密西西比河和俄亥俄河流域以及中美洲和南美洲的部分地区。由于气候变化和人为土地利用，适合组织胞浆菌生长的条件正在发生变化，导致流行病学也相应发生变化。组织胞浆菌病的临床表现多种多样，类似于社区获得性肺炎、肺结核、结节病、克罗恩病或恶性肿瘤等常见疾病。成功诊断的关键是全面了解流行病学、常见临床表现以及组织胞浆菌病的最佳检测实践。虽然大多数无症状或自限性疾病在免疫功能正常的患者中不需要治疗，但所有免疫功能低下的患者以及患有进行性播散性疾病或慢性肺部疾病的患者都应接受治疗。对于严重或播散性疾病，两性霉素 B 脂质体是首选药物，而伊曲康唑对于轻度疾病和两性霉素 B 治疗后的“降级”治疗是足够的。在这篇综述中，我们讨论了组织胞浆菌病的流行病学、诊断和管理的循证方法。
