Bradsher R W
Division of Infectious Diseases, University of Arkansas for Medical Sciences, Little Rock 72205, USA.
Clin Infect Dis. 1996 May;22 Suppl 2:S102-11. doi: 10.1093/clinids/22.supplement_2.s102.
Histoplasmosis and blastomycosis are caused by dimorphic fungi, can be epidemic or endemic, and can produce a spectrum of illness, from subclinical infection to progressive disseminated disease. Diagnosis of both is best made by visualization of yeast in tissue or by culture. Itraconazole is the drug of choice for treatment of both histoplasmosis and blastomycosis, except in cases of life-threatening infection, for which amphotericin B is indicated. A heavy inoculum of Histoplasma capsulatum may cause acute pulmonary infection in an otherwise healthy host, resulting in fever, hypoxia, and pulmonary infiltrates. Opportunistic histoplasmosis develops as chronic pulmonary histoplasmosis in those with a structural defect in the lung (emphysema) or as disseminated histoplasmosis in patients with cellular immune deficiency (due to immunosuppressants or AIDS). Blastomyces dermatitidis causes both pulmonary and extrapulmonary disease. Lung involvement may mimic bacterial pneumonia, while chronic presentations mimic lung cancer or tuberculosis. Skin is the most common extrapulmonary site of disease, followed by bone, prostate, and central nervous system.
组织胞浆菌病和芽生菌病由双相真菌引起，可为流行性或地方性疾病，可引发一系列病症，从亚临床感染到进行性播散性疾病。二者的诊断最好通过在组织中观察到酵母或通过培养来进行。除危及生命的感染病例需使用两性霉素B外，伊曲康唑是治疗组织胞浆菌病和芽生菌病的首选药物。大量荚膜组织胞浆菌接种可能在原本健康的宿主中引起急性肺部感染，导致发热、缺氧和肺部浸润。机会性组织胞浆菌病在肺部存在结构缺陷（肺气肿）的患者中发展为慢性肺部组织胞浆菌病，或在细胞免疫缺陷患者（由于免疫抑制剂或艾滋病）中发展为播散性组织胞浆菌病。皮炎芽生菌可导致肺部和肺外疾病。肺部受累可能类似细菌性肺炎，而慢性表现则类似肺癌或肺结核。皮肤是最常见的肺外疾病部位，其次是骨骼、前列腺和中枢神经系统。
