Wheat J
Indiana University School of Medicine, Indianapolis.
Clin Infect Dis. 1994 Aug;19 Suppl 1:S19-27. doi: 10.1093/clinids/19.supplement_1.s19.
Histoplasmosis has become an important mycosis in regions of endemicity in North and Central America. Traditionally, treatment has been reserved for patients with disseminated or chronic pulmonary histoplasmosis. The availability of safe and effective oral regimens, however, has offered alternatives to amphotericin B. Administration of amphotericin B is highly effective as therapy and produces a rapid clinical response; it remains the treatment of choice for patients with severe or moderately severe manifestations of histoplasmosis. Ketoconazole and itraconazole are well tolerated and are effective alternatives to amphotericin B for treatment of patients with milder illnesses or for use following response to amphotericin B. The determination of fluconazole's role in therapy for histoplasmosis awaits completion of ongoing trials. Continued research is needed to develop better-tolerated fungicidal alternatives to amphotericin B and oral agents with better absorption and drug interaction profiles than those of itraconazole and ketoconazole. Preventive strategies should be explored to reduce the frequency of histoplasmosis among individuals from regions of endemicity who are at high risk for more severe manifestations of histoplasmosis.
组织胞浆菌病已成为北美和中美洲地方病流行区域的一种重要真菌病。传统上，治疗仅适用于播散性或慢性肺组织胞浆菌病患者。然而，安全有效的口服治疗方案的出现，为两性霉素B提供了替代选择。两性霉素B作为治疗药物非常有效，能产生快速的临床反应；它仍然是组织胞浆菌病重度或中度重度表现患者的首选治疗药物。酮康唑和伊曲康唑耐受性良好，是治疗病情较轻患者或在对两性霉素B产生反应后使用的有效替代药物，可替代两性霉素B。氟康唑在组织胞浆菌病治疗中的作用有待正在进行的试验完成后确定。需要继续开展研究，以开发耐受性更好的两性霉素B杀真菌替代药物，以及吸收和药物相互作用情况优于伊曲康唑和酮康唑的口服药物。应探索预防策略，以降低来自地方病流行区域且组织胞浆菌病重度表现高危个体中该病的发病率。
