Salzman S H, Smith R L, Aranda C P
Bellevue Chest Service, New York Veterans Administration Medical Center, New York.
Chest. 1988 May;93(5):916-21. doi: 10.1378/chest.93.5.916.
We reviewed 18 cases of histoplasmosis in patients at risk for the acquired immunodeficiency syndrome seen at two New York City hospitals in the past 3 1/2 years. Seventeen patients were Hispanic, including 13 born in Puerto Rico and three in South America. Clinical presentation was subacute, with high fever, weight loss, and mild respiratory symptoms with well-maintained gas exchange. Five patients had normal chest roentgenograms. The most common chest roentgenographic abnormality was diffuse small nodules. A rapid diagnosis was established histologically in 72 percent of patients, most commonly by transbronchial lung biopsy; cultures were positive in 94 percent of patients while serology was positive in five of six patients. Mycobacterium tuberculosis was a concurrent, often unrecognized, pathogen in six cases. Most patients responded to amphotericin therapy. Histoplasmosis may represent an early sign of altered host immunity in the acquired immunodeficiency syndrome.
我们回顾了过去3年半在纽约市两家医院就诊的18例获得性免疫缺陷综合征高危患者的组织胞浆菌病病例。17例患者为西班牙裔，其中13例出生于波多黎各，3例出生于南美洲。临床表现为亚急性，有高热、体重减轻和轻度呼吸道症状，气体交换良好。5例患者胸部X线片正常。最常见的胸部X线异常是弥漫性小结节。72%的患者通过组织学检查迅速确诊，最常见的方法是经支气管肺活检；94%的患者培养呈阳性，而6例患者中有5例血清学呈阳性。结核分枝杆菌在6例病例中是一种并发的、常常未被识别的病原体。大多数患者对两性霉素治疗有反应。组织胞浆菌病可能是获得性免疫缺陷综合征中宿主免疫改变的早期迹象。
