Yglesias Dimadi Ioanna I, Clinton Hidalgo Madelyn, Hernández Chavarría Vivian I, Min Kim Hery, Castro Torres Grettel R
General Medicine, Universidad de Costa Rica, San Jose, CRI.
Pediatric Medicine, Caja Costarricense del Seguro Social, San Jose, CRI.
Cureus. 2023 Jul 7;15(7):e41493. doi: 10.7759/cureus.41493. eCollection 2023 Jul.
Histoplasmosis is a mycosis caused by , a dimorphic fungus endemic to areas with nitrogen-rich soil, like the one contaminated with bird and bat excrement. Patients with a deficient immune response are especially at risk for developing invasive infections, such as disseminated histoplasmosis, and secondary immunodeficiency can be a consequence of malnutrition. This case report presents a 15-month-old male infant with malnutrition who presented with signs and symptoms of disseminated histoplasmosis, including fever, malaise, weight loss, cough, and diarrhea. The infant came from a geographic area where histoplasmosis is endemic, and he was a member of a cultural group with a higher prevalence of histoplasmosis than the general population. On physical examination, hepatosplenomegaly, lymphadenopathy, and lung crackles were found, which are common in most patients with histoplasmosis. The keystone of diagnosis of infection is antigen detection, but the criterion standard is isolation of the organism from body specimens through laboratory culture. Histological diagnosis is especially useful for rapid diagnosis. Treatment of disseminated histoplasmosis in the pediatric population consists of deoxycholate amphotericin B for four to six weeks followed by itraconazole to complete a total of three months of treatment. Despite the involvement of multiple organ systems, the patient recovered satisfactorily after the completion of amphotericin B treatment for one month and the resolution of his malnourishment.
组织胞浆菌病是一种由荚膜组织胞浆菌引起的真菌病，荚膜组织胞浆菌是一种二态真菌，在土壤含氮丰富的地区（如被鸟类和蝙蝠粪便污染的地区）为地方病。免疫反应不足的患者尤其有发生侵袭性感染的风险，如播散性组织胞浆菌病，而继发性免疫缺陷可能是营养不良的后果。本病例报告介绍了一名15个月大的营养不良男婴，他出现了播散性组织胞浆菌病的体征和症状，包括发热、不适、体重减轻、咳嗽和腹泻。该婴儿来自组织胞浆菌病的地方流行区，且属于组织胞浆菌病患病率高于普通人群的文化群体。体格检查发现肝脾肿大、淋巴结病和肺部啰音，这些在大多数组织胞浆菌病患者中很常见。荚膜组织胞浆菌感染诊断的关键是抗原检测，但标准方法是通过实验室培养从身体标本中分离出该病原体。组织学诊断对快速诊断特别有用。儿童播散性组织胞浆菌病的治疗包括使用脱氧胆酸盐两性霉素B治疗四至六周，随后使用伊曲康唑，共完成三个月的治疗。尽管多个器官系统受累，但在完成两性霉素B治疗一个月且营养不良问题得到解决后，患者恢复良好。
