Chapman S W, Lin A C, Hendricks K A, Nolan R L, Currier M M, Morris K R, Turner H R
Department of Internal Medicine, University of Mississippi Medical Center, Jackson 39216-4505, USA.
Semin Respir Infect. 1997 Sep;12(3):219-28.
In order to clarify the epidemiology and clinical spectrum of endemic blastomycosis, we reviewed the charts of 326 culture and/or histologically proven cases of blastomycosis in Mississippi from 1979 to 1988. Cases were dispersed throughout the state, but counties in central and south-central Mississippi reported 63% of all blastomycosis cases. The average annual incidence rate was 1.3 cases per 100,000 population. The majority of cases were in men (male to female ratio 1.7:1), and most patients were aged in their third through seventh decades (82%). Outdoor occupations were noted for only 28.9% of cases. Cases occurred throughout the year with no significant seasonal peak. Although 55% saw a physician within 7 days of onset of illness, 29% presented after 1 month. Despite early presentation, diagnosis was often delayed for more than 1 month (43.3%). Single organs were involved in 82.8% of cases. For all cases, organ systems involved included lungs (91.4%), skin (18.1%), bone (4.3%), genitourinary system (1.8%), and central nervous system (1.2%). The presence of skin or bone disease was associated with multiorgan involvement. Thirty-three patients died (11.5%), 6 of whom received no therapy. Patients who died were significantly older than those who survived. A successful outcome without relapse was noted in 86.5% of amphotericin B-treated patients and in 81.7% of ketoconazole-treated patients. The relapse rate for ketoconazole-treated patients was higher than for amphotericin B-treated patients (14% and 3.9% respectively).
为了阐明地方性芽生菌病的流行病学和临床谱，我们回顾了1979年至1988年密西西比州326例经培养和/或组织学证实的芽生菌病病例的病历。病例分布于全州，但密西西比州中部和中南部的县报告了所有芽生菌病病例的63%。年平均发病率为每10万人1.3例。大多数病例为男性（男女比例为1.7:1），大多数患者年龄在30多岁至70多岁（82%）。仅28.9%的病例从事户外职业。病例全年均有发生，无明显季节性高峰。尽管55%的患者在发病后7天内就医，但29%的患者在发病1个月后才就诊。尽管就诊较早，但诊断往往延迟超过1个月（43.3%）。82.8%的病例累及单个器官。所有病例累及的器官系统包括肺（91.4%）、皮肤（18.1%）、骨（4.3%）、泌尿生殖系统（1.8%）和中枢神经系统（1.2%）。皮肤或骨病的存在与多器官受累相关。33例患者死亡（11.5%），其中6例未接受治疗。死亡患者明显比存活患者年龄大。两性霉素B治疗的患者中86.5%获得了无复发的成功结局，酮康唑治疗的患者中这一比例为81.7%。酮康唑治疗患者的复发率高于两性霉素B治疗的患者（分别为14%和3.9%）。
