Dietrich P Y, Bille J, Fontolliet C, Regamey C
Service de médecine interne, Hôpital cantonal, Fribourg.
Schweiz Med Wochenschr. 1987 Aug 29;117(35):1289-96.
Very commonly encountered in the United States, histoplasmosis is rare in Europe, where only 27 patients have so far been infected by this mycosis. In Africa, two varieties of histoplasmosis have been observed: those due to H. capsulatum and H. duboisii. Histoplasmosis due to H. capsulatum is one of the twelve secondary infectious diseases listed in the surveillance definitions of AIDS. This complication has been described only in approximately 20 patients with AIDS; all patients had stayed on the American Continents. We report the case of a 30-year-old African male who lived in Switzerland and in Zaïre. With AIDS and multiple Kaposi's sarcoma, the patient died from disseminated histoplasmosis due to H. capsulatum; a peripheral blood smear obtained a few hours before death revealed numerous typical yeast forms of H. capsulatum inside polymorphonuclear leukocytes. Post-mortem examination and cultures confirmed the diagnosis of disseminated histoplasmosis. Histoplasmosis should be suspected in AIDS patients even in Europe, especially where they have stayed in endemic areas. Examination of blood smears and bonemarrow aspirate may allow early recognition of the disease and permit appropriate treatment with amphotericin B and ketoconazole.
组织胞浆菌病在美国极为常见，但在欧洲却很罕见，目前欧洲仅有27例患者感染这种真菌病。在非洲，已观察到两种组织胞浆菌病：由荚膜组织胞浆菌和杜波依斯组织胞浆菌引起的。由荚膜组织胞浆菌引起的组织胞浆菌病是艾滋病监测定义中列出的十二种继发性传染病之一。这种并发症仅在约20例艾滋病患者中被描述过；所有患者都曾居住在美洲大陆。我们报告一例30岁非洲男性病例，该患者曾居住在瑞士和扎伊尔。患有艾滋病和多发性卡波西肉瘤，该患者死于由荚膜组织胞浆菌引起的播散性组织胞浆菌病；死亡前数小时采集的外周血涂片显示多形核白细胞内有大量典型的荚膜组织胞浆菌酵母形态。尸检和培养证实了播散性组织胞浆菌病的诊断。即使在欧洲，艾滋病患者也应怀疑患有组织胞浆菌病，特别是在他们曾居住于流行地区的情况下。检查血涂片和骨髓穿刺液可能有助于早期识别该病，并允许使用两性霉素B和酮康唑进行适当治疗。
