Department of Internal Medicine, Section of Infectious Diseases, School of Medicine, Yale University, New Haven, Connecticut.
Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Arizona College of Medicine, Tucson, Arizona.
Semin Respir Crit Care Med. 2020 Aug;41(4):522-537. doi: 10.1055/s-0040-1702194. Epub 2020 Jul 6.
In endemic areas, dimorphic fungal infections due to , and account for up to 30% of cases of community-acquired pneumonia. Because respiratory manifestations are often indistinguishable from common bacterial causes of pneumonia, the diagnosis of pulmonary histoplasmosis, blastomycosis, and coccidioidomycosis is often delayed and associated with antibiotics overuse. In addition to being highly endemic to certain regions of North America, dimorphic fungi have global significance due to established areas of endemicity in all six inhabited continents, an increasingly interconnected world of travelers and transported goods, and a changing epidemiology as a result of global heating and anthropomorphic land utilization. In this review, we discuss the epidemiology, pathogenesis, clinical presentation, diagnostic modalities, and treatment strategies for histoplasmosis, blastomycosis, and coccidioidomycosis.
在流行地区，由 和 引起的二相真菌感染占社区获得性肺炎病例的 30%。由于呼吸道表现常与常见细菌性肺炎难以区分，因此肺组织胞浆菌病、球孢子菌病和粗球孢子菌病的诊断常被延误，并与抗生素过度使用有关。除了在北美的某些地区高度流行外，由于在所有六个有人居住的大陆都有已确定的流行地区、旅行者和运输货物的世界日益相互关联，以及由于全球变暖以及人为土地利用而导致的流行病学变化，二相真菌具有全球意义。在这篇综述中，我们讨论了组织胞浆菌病、球孢子菌病和粗球孢子菌病的流行病学、发病机制、临床表现、诊断方法和治疗策略。
