Guo Xiaoxiao, Ruan Qiaoling, Jin Jialin, Zheng Jianming, Shao Lingyun, Li Ning, Zhu Liping, Zhang Wenhong, Hu Yuekai, Chen Mingquan
Department of Infectious Diseases, National Medical Center for Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China.
Eur J Clin Microbiol Infect Dis. 2022 Jun;41(6):925-939. doi: 10.1007/s10096-022-04447-y. Epub 2022 May 12.
Coccidioidomycosis is caused by the dimorphic fungi Coccidioides species which is endemic in the Western hemisphere. Reports on the characteristics of travel-related disseminated coccidioidomycosis in immunocompetent patients are rare, especially in non-endemic regions. The multifaceted symptoms of this condition present a diagnostic challenge to clinicians. This study aimed to review immunocompetent patients diagnosed with disseminated coccidioidomycosis in a tertiary hospital in Eastern China and other non-endemic areas, and to emphasize the importance of combining travel history with clinical manifestations and proper diagnostic examinations. This study retrospectively reviewed a case series of disseminated coccidioidomycosis diagnosed in an academic hospital in Eastern China. We conducted a global literature review of disseminated coccidioidomycosis in immunocompetent patients with travel history. We identified six patients in our case series and reviewed 42 cases in the literature. Travel history included Mexico, Arizona, California, and regions of low endemicity. Extrapulmonary sites of infection, which presented with diverse signs and symptoms, involved the skin and soft tissue, musculoskeletal system, lymph nodes, and central nervous system. Misdiagnoses and diagnostic delays were common. Next-generation sequencing substantially promoted precise diagnosis in our series. The overall prognosis for immunocompetent individuals was positive, mainly benefited from long-term azole therapies. The patients that succumbed had either central nervous system involvement or multiorgan dissemination. Progressive pneumonia with varied symptoms and travel history should alert healthcare professionals in non-endemic areas to consider the possibility of Coccidioides species infection. We recommend detailed history-taking and hypothesis-free detection of pathogens for cases with diagnostic delay.
球孢子菌病由双相真菌球孢子菌属引起，该菌在西半球为地方病。关于免疫功能正常患者旅行相关播散性球孢子菌病特征的报道很少，尤其是在非流行地区。这种疾病的多方面症状给临床医生带来了诊断挑战。本研究旨在回顾在中国东部及其他非流行地区一家三级医院诊断为播散性球孢子菌病的免疫功能正常患者，并强调结合旅行史、临床表现和适当诊断检查的重要性。本研究回顾性分析了在中国东部一家学术医院诊断的一系列播散性球孢子菌病病例。我们对有旅行史的免疫功能正常患者的播散性球孢子菌病进行了全球文献综述。我们在病例系列中确定了6例患者，并回顾了文献中的42例病例。旅行史包括墨西哥、亚利桑那州、加利福尼亚州以及低流行地区。肺外感染部位表现出多样的体征和症状，包括皮肤和软组织、肌肉骨骼系统、淋巴结和中枢神经系统。误诊和诊断延迟很常见。新一代测序在我们的系列研究中极大地促进了精确诊断。免疫功能正常个体的总体预后良好，主要得益于长期唑类治疗。死亡患者要么有中枢神经系统受累，要么有多器官播散。症状多样且有旅行史的进行性肺炎应提醒非流行地区的医护人员考虑球孢子菌属感染的可能性。对于诊断延迟的病例，我们建议详细询问病史并进行无假设的病原体检测。
