Operational Infectious Diseases Directorate, Naval Health Research Center, San Diego, CA, USA.
Uniformed Services University School of Medicine, Bethesda, MD, USA.
BMC Infect Dis. 2023 Jun 26;23(1):430. doi: 10.1186/s12879-023-08379-6.
Coccidioidomycosis is a fungal infection endemic to the southwestern United States and regions of Latin America. Disseminated disease occurs in < 1% of cases. Septic shock is even rarer, with high mortality despite therapy. We describe two cases of coccidioidal septic shock. Both patients were older men of Filipino ancestry presenting with respiratory failure and vasopressor-dependent shock. Antifungal drugs were initiated after failure to improve with empiric antibiotics; in both, Coccidioides was isolated from respiratory cultures. Despite aggressive care, both patients ultimately died of their infections. We provide a review of the published literature on this topic.
Most of the 33 reported cases of coccidioidal septic shock occurred in men (88%) of non-white race and ethnicity (78%). The overall mortality rate was 76%. All survivors received amphotericin B as part of their treatment. Coccidioidomycosis-related septic shock is a rare disease with poor outcomes; delays in diagnosis and treatment are common. Improved diagnostic testing for coccidioidomycosis could enhance recognition of this disease in the future. Although data are limited, early treatment with amphotericin B in cases of coccidioidal septic shock may reduce mortality.
球孢子菌病是一种真菌病，流行于美国西南部和拉丁美洲的一些地区。<1%的病例会发生播散性疾病。即使经过治疗，感染性休克也更为罕见，但死亡率很高。我们描述了两例球孢子菌感染性休克。两名患者均为年长的菲律宾裔男性，表现为呼吸衰竭和需要升压药物维持的休克。在经验性使用抗生素治疗无效后，开始使用抗真菌药物；在这两例患者中，均从呼吸道培养物中分离出了球孢子菌。尽管采取了积极的治疗措施，但两名患者最终均因感染而死亡。我们对该主题的已发表文献进行了综述。
在 33 例报道的球孢子菌感染性休克病例中，大多数（88%）发生于非白种人（78%）男性。总体死亡率为 76%。所有幸存者均接受了两性霉素 B 治疗。与球孢子菌病相关的感染性休克是一种罕见疾病，预后较差；诊断和治疗的延误很常见。未来可能需要改进球孢子菌病的诊断检测，以提高对这种疾病的认识。尽管数据有限，但在球孢子菌感染性休克的情况下早期使用两性霉素 B 治疗可能会降低死亡率。
