McKinsey D S, Spiegel R A, Hutwagner L, Stanford J, Driks M R, Brewer J, Gupta M R, Smith D L, O'Connor M C, Dall L
Infectious Disease Associates of Kansas City, University of Missouri-Kansas City School of Medicine, St. Luke's Hospital, USA.
Clin Infect Dis. 1997 Jun;24(6):1195-203. doi: 10.1086/513653.
Histoplasmosis is a common opportunistic infection in patients with human immunodeficiency virus (HIV) infection who reside in areas where Histoplasma capsulatum is endemic. We undertook a prospective study of a cohort of 304 HIV-Infected patients in Kansas City from October 1990 through March 1993 to define the incidence-specific risk factors, and pathophysiology of histoplasmosis. The annual incidence of histoplasmosis was 4.7%; 74% of the patients with histoplasmosis were symptomatic (all of whom had disseminated disease). A history of exposure to chicken coops, a positive baseline serology for complement-fixing antibodies to Histoplasma mycelium antigen, and a baseline CD4+ lymphocyte count of < 150/microL were associated with an increased risk for histoplasmosis. Histoplasmin reactivity and the presence of pulmonary calcifications were not useful markers for patients at high risk. Symptomatic infection occurred in 9.9% of patients with evidence of prior exposure to H. capsulatum, in 4.0% of patients without documented prior exposure, and in 3.0% of patients who were anergic; these findings suggest that the pathophysiology of histoplasmosis in patients with AIDS involves reactivation of latent infection in some cases and dissemination of exogenously acquired infection in other cases.
组织胞浆菌病是居住在荚膜组织胞浆菌流行地区的人类免疫缺陷病毒（HIV）感染患者中常见的机会性感染。我们于1990年10月至1993年3月对堪萨斯城的304名HIV感染患者进行了一项前瞻性队列研究，以确定组织胞浆菌病的发病率、特定危险因素和病理生理学。组织胞浆菌病的年发病率为4.7%；74%的组织胞浆菌病患者有症状（所有患者均为播散性疾病）。接触鸡舍的病史、针对组织胞浆菌菌丝体抗原的补体固定抗体基线血清学阳性以及基线CD4+淋巴细胞计数<150/μL与组织胞浆菌病风险增加相关。组织胞浆菌素反应性和肺部钙化的存在对高危患者不是有用的标志物。有证据表明既往接触过荚膜组织胞浆菌的患者中9.9%发生有症状感染，无记录的既往接触史的患者中4.0%发生有症状感染，无反应性的患者中3.0%发生有症状感染；这些发现表明，艾滋病患者中组织胞浆菌病的病理生理学在某些情况下涉及潜伏感染的重新激活，在其他情况下涉及外源性获得性感染的播散。
