Kauffman C A, Israel K S, Smith J W, White A C, Schwarz J, Brooks G F
Am J Med. 1978 Jun;64(6):923-32. doi: 10.1016/0002-9343(78)90445-x.
Infection with Histoplasma capsulatum in 58 patients whose immune responses were suppressed (Immunosuppressed patients) (16 from the present series and 42 described previously) was analyzed. The most common underlying diseases were Hodgkin's disease (29 per cent), chronic lymphocytic leukemia (19 per cent) and acute lymphocytic leukemia (17 per cent). Sixty-three per cent of the patients had received cytotoxic drugs, and 57 per cent had taken corticosteroids. Widely disseminated infection occurred in 88 per cent of the patients, with predominant involvement of lungs and organs of the reticuloendothelial system. Localized pulmonary infection was present in the remaining patients. The most useful diagnostic method was bone marrow biopsy with microscopic examination for the intracellular yeast form of H. capsulatum. Biopsy of oral lesions, lung, liver and lymph node also proved diagnostically helpful. Growth of H. capsulatum in culture was frequently too slow to be beneficial in diagnosing histoplasmosis in ill patients. Serologic methods were of little diagnostic help in this population of immunosuppressed patients. The response to amphotericin B therapy was excellent (6.7 per cent mortality rate) in those patients in whom the diagnosis was established early and in whom a full course of antifungal therapy could be given. In contrast, the mortality rate in patients who received no antifungal therapy or less than 1 g of amphotericin B was 100 per cent.
对58例免疫反应受到抑制的患者（免疫抑制患者）（本系列16例，先前报道42例）感染荚膜组织胞浆菌的情况进行了分析。最常见的基础疾病是霍奇金病（29%）、慢性淋巴细胞白血病（19%）和急性淋巴细胞白血病（17%）。63%的患者接受过细胞毒性药物治疗，57%的患者使用过皮质类固醇。88%的患者发生广泛播散性感染，主要累及肺部和网状内皮系统器官。其余患者为局限性肺部感染。最有用的诊断方法是骨髓活检并通过显微镜检查荚膜组织胞浆菌的细胞内酵母形式。口腔病变、肺、肝和淋巴结活检也证明有助于诊断。荚膜组织胞浆菌在培养中的生长通常过于缓慢，对诊断患病患者的组织胞浆菌病没有帮助。血清学方法对这群免疫抑制患者的诊断帮助不大。在那些早期确诊且能够接受全程抗真菌治疗的患者中，两性霉素B治疗的反应良好（死亡率为6.7%）。相比之下，未接受抗真菌治疗或接受少于1g两性霉素B治疗的患者死亡率为100%。
