Arsura E L, Bellinghausen P L, Kilgore W B, Abraham J J, Johnson R H
Department of Medicine, Kern Medical Center, Bakersfield, CA 93305, USA.
Crit Care Med. 1998 Jan;26(1):62-5. doi: 10.1097/00003246-199801000-00017.
To describe the clinical and laboratory parameters of patients with septic shock following infection with Coccidioides immitis, estimate the incidence of septic shock from coccidioidomycosis, and outline clues that may be helpful in early diagnosis of this syndrome.
Retrospective, descriptive case series.
A 250-bed general public hospital in Kern County, CA.
Eight patients diagnosed with septic shock from infection with C. immitis from September 1991 to December 1993. Five were Hispanic, two were Filipino, and one was African-American. The diagnosis of C. immitis was made by microscopic examination and culture of the organism from sputum or other sites. Septic shock was diagnosed using criteria formulated by the American College of Chest Physicians Consensus Conference/Society of Critical Care Medicine.
No patient had traditional immunocompromising conditions. All patients had pulmonary symptoms and were symptomatic for a mean duration of 19.4 +/- 19.8 days before admission. One patient presented with septic shock and the remaining seven developed shock during their hospital course. Serology for coccidioidomycosis was positive in six patients. The mean cardiac index was 5.8 +/- 1.9 (SD) L/min/m2, the mean arterial pressure was 71.0 +/- 16.7 mm Hg, the mean pulmonary artery occlusion pressure was 16.9 +/- 3.5 mm Hg, and the mean systemic volume resistance index was 846.6 +/- 224.1 dyne-sec/cm5xm2. All patients developed acute respiratory distress syndrome. Coccidioidomycosis was recognized or considered in only five of eight patients before they developed septic shock. Despite therapy with amphotericin B, all patients died. One patient died of progressive pulmonary disease, two patients suffered an acute arrest, and five patients developed progressive multiple organ system failure and died with additional organ involvement.
Septic shock following infection with C. immitis is an ominous yet underrecognized condition. Hemodynamic parameters and cytokine concentrations were not significantly different from values seen in gram-negative septic shock. Clinical clues to the diagnosis include duration of illness and conspicuous pulmonary involvement. Patient outcome in this series was poor but may improve with increased recognition of septic shock in infections from C. immitis.
描述感染粗球孢子菌后发生感染性休克患者的临床和实验室参数，估计球孢子菌病所致感染性休克的发病率，并概述可能有助于该综合征早期诊断的线索。
回顾性描述性病例系列研究。
加利福尼亚州克恩县一家拥有250张床位的综合公立医院。
1991年9月至1993年12月期间8例因感染粗球孢子菌而诊断为感染性休克的患者。其中5例为西班牙裔，2例为菲律宾裔，1例为非裔美国人。通过对痰液或其他部位的标本进行显微镜检查和培养来诊断粗球孢子菌感染。采用美国胸科医师学会共识会议/危重病医学会制定的标准诊断感染性休克。
所有患者均无传统的免疫功能低下情况。所有患者均有肺部症状，入院前症状平均持续时间为19.4±19.8天。1例患者入院时即表现为感染性休克，其余7例在住院期间发生休克。6例患者球孢子菌病血清学检查呈阳性。平均心脏指数为5.8±1.9（标准差）L/min/m²，平均动脉压为71.0±16.7 mmHg，平均肺动脉楔压为16.9±3.5 mmHg，平均全身血管阻力指数为846.6±224.1达因·秒/cm⁵·m²。所有患者均发生急性呼吸窘迫综合征。8例患者中仅5例在发生感染性休克前被识别或考虑患有球孢子菌病。尽管使用两性霉素B进行治疗，所有患者均死亡。1例死于进行性肺部疾病，2例发生急性心跳骤停，5例出现进行性多器官系统功能衰竭，并伴有其他器官受累而死亡。
感染粗球孢子菌后发生的感染性休克是一种凶险但未得到充分认识的疾病。血流动力学参数和细胞因子浓度与革兰阴性菌所致感染性休克的值无显著差异。诊断的临床线索包括病程和明显的肺部受累情况。本系列患者的预后较差，但随着对粗球孢子菌感染所致感染性休克认识的提高，预后可能会有所改善。
