Troillet N, Llor J, Kuchler H, Delèze G, Praz G
Division of Infectious Diseases, Valais Central Institute, Sion, Switzerland.
Eur J Pediatr. 1996 Jun;155(6):474-6. doi: 10.1007/BF01955184.
An HIV-negative 4-month-old infant recently adopted from El Salvador was admitted for high fever. Hepatosplenomegaly, anaemia, leucopenia, thrombocytopenia, increased transaminases, and diffuse interstitial pulmonary infiltration were present on admission. Granulomas were seen in bone marrow and liver biopsies without any organism. Disseminated histoplasmosis was diagnosed 2 weeks later when bone marrow and blood cultures taken on admission became positive for Histoplasma capsulatum and when histoplasmic antigen was detected in blood. The outcome was good after treatment with amphotericin B followed by itraconazole which was administered for a 6-month period without significant toxicity.
Disseminated histoplasmosis is very rarely seen in Europe but should be suspected in case of unexplained fever in immigrants from the endemic areas in the world, particularly when hepatosplenomegaly and pancytopenia are present. Bone marrow examination and culture, blood cultures, and antigen testing are the mainstays of the diagnosis.
一名最近从萨尔瓦多领养的4个月大HIV阴性婴儿因高热入院。入院时存在肝脾肿大、贫血、白细胞减少、血小板减少、转氨酶升高及弥漫性间质性肺浸润。骨髓和肝脏活检可见肉芽肿，但未发现任何病原体。入院时采集的骨髓和血培养2周后对荚膜组织胞浆菌呈阳性，且血液中检测到组织胞浆菌抗原，此时诊断为播散性组织胞浆菌病。使用两性霉素B治疗后接着使用伊曲康唑治疗6个月，未出现明显毒性，预后良好。
播散性组织胞浆菌病在欧洲非常罕见，但对于来自世界疫区的移民出现不明原因发热时应怀疑该病，尤其是存在肝脾肿大和全血细胞减少时。骨髓检查及培养、血培养和抗原检测是诊断的主要依据。
