Schutze G E, Hickerson S L, Fortin E M, Schellhase D E, Darville T, Gubbins P O, Jacobs R F
University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, USA.
Clin Infect Dis. 1996 Mar;22(3):496-502. doi: 10.1093/clinids/22.3.496.
Infections due to Blastomyces dermatitidis are not commonly encountered in children and adolescents. Knowledge of the diagnosis and treatment of this disease is largely based upon experience with adult patients. We recently reviewed our experience with blastomycosis to evaluate the difficulties in diagnosis and treatment of this disease in the pediatric population. Ten patients with blastomycosis were identified during our review, and five had pulmonary disease alone. Of these five patients, four required open-lung biopsy for diagnosis, even though three had previously undergone bronchoalveolar lavage. The response to treatment with the oral azole antifungal agents (ketoconazole, fluconazole, and itraconazole) was limited, and the agent with the greatest success remains amphotericin B. Until more data are available, amphotericin B should be used for complicated and life-threatening cases of blastomycosis. If oral azole agents are used for non-life-threatening cases, patients should be followed closely, and if clinical deterioration occurs or serum levels of medications are not adequate, then amphotericin B should be substituted for the oral azole agent.
皮炎芽生菌感染在儿童和青少年中并不常见。对这种疾病的诊断和治疗知识很大程度上基于成人患者的经验。我们最近回顾了我们治疗芽生菌病的经验，以评估儿科人群中这种疾病在诊断和治疗方面的困难。在我们的回顾中确定了10例芽生菌病患者，其中5例仅患有肺部疾病。在这5例患者中，4例需要进行开胸肺活检以进行诊断，尽管其中3例之前已经接受过支气管肺泡灌洗。口服唑类抗真菌药物（酮康唑、氟康唑和伊曲康唑）的治疗反应有限，最成功的药物仍然是两性霉素B。在获得更多数据之前，两性霉素B应用于治疗复杂的、危及生命的芽生菌病病例。如果口服唑类药物用于非危及生命的病例，患者应密切随访，如果出现临床恶化或药物血清水平不足，则应将两性霉素B替代口服唑类药物。
