Laskey W, Sarosi G A
Ann Intern Med. 1978 Jan;88(1):50-2. doi: 10.7326/0003-4819-88-1-50.
Recent work established the fact that the portal of entry in blastomycosis is the lung. After the initial exposure to the fungus, a pneumonic process develops that may heal spontaneously or progress locally or at distant sites, or both. Frequently, however, patients present with disseminated disease, whose chest roentgenograms do not show any lesions. We have recently seen three patients with disseminated blastomycosis with negative chest roentgenograms at the time of diagnosis. Past history showed a pneumonic illness 33, 32, and 4 months before diagnosis. Chest roentgenograms from the time of the original illness showed a pneumonic process compatible with blastomycosis in all three. Examination of postbronchoscopy sputa showed the characteristic yeasts of Blastomyces dermatitidis. These three patients document for the first time apparent endogenous activation in blastomycosis. A possible explanation for this apparent endogenous activation may reside in the histopathologic similarity between blastomycosis and other chronic granulomatous diseases, especially tuberculosis.
最近的研究证实，芽生菌病的感染途径是肺部。初次接触真菌后，会引发肺部病变，这种病变可能会自行愈合，也可能在局部或远处发展，或者两者皆有。然而，患者常常表现为播散性疾病，其胸部X线片却未显示任何病变。我们最近就遇到了三名播散性芽生菌病患者，诊断时胸部X线片均为阴性。既往史显示，在诊断前33个月、32个月和4个月曾患肺炎。最初患病时的胸部X线片显示，三名患者均有与芽生菌病相符的肺部病变。支气管镜检查后的痰液检查发现了皮炎芽生菌的特征性酵母。这三名患者首次证明了芽生菌病中明显的内源性激活现象。这种明显的内源性激活的一个可能解释可能在于芽生菌病与其他慢性肉芽肿性疾病，尤其是结核病之间的组织病理学相似性。
