コルチコステロイドで治療された患者における拡散性ヒストプラズモシス. 5件の事件の報告
JAMA
|September 29, 1978
まとめ
コルチコステロイド療法は,持続的な発熱を呈する患者に拡散性ヒストプラズモシス (DH) を引き起こす可能性があります. 早期の診断と治療は,これらの免疫不全の個体での結果を改善するために不可欠です.
科学分野:
- 医学菌学 医学菌学について
- 感染症 感染症は感染症です.
- 免疫不全の宿主の研究
背景:
- ヒストプラズマカプスラトゥームは通常,オポチュニスティックとは考えられない.
- コルチコステロイドの使用は,免疫反応を変化させ,感染に対する感受性を潜在的に高めることができます.
研究 の 目的:
- コルチコステロイドで治療された患者における分散性ヒストプラズモシス (DH) の発生を調査する.
- この患者グループにおけるDHの臨床的および病理学的特徴を特定する.
- 診断方法とその予後への影響を評価する.
主な方法:
- 散布性ヒストプラズモシスでコルチコステロイドを投与された5人の患者の遡及的ケースシリーズ分析.
- 臨床プレゼンテーション,診断結果 (骨髄培養を含む),病理学的特徴のレビュー.
- 診断遅延と患者のアウトカムとの相関.
主要な成果:
- コルチコステロイド療法を受けた5人の患者は,拡散ヒストプラズモシスを発症した.
- 原因不明で持続する発熱が主な症状でした.
- 病理学的発見には,マクロファージ内の多数の酵母形態,欠席の粒腫,最小限の炎症が含まれていました.
- 骨髄培養は,最適な診断研究として特定されました.
- 診断の遅延は予後不良と関連しており,4人の死亡は直接DHに起因していた.
結論:
- コルチコステロイド療法は,患者を拡散ヒストプラズモシスに誘発する可能性があります.
- 免疫不全の患者,特にコルチコステロイドを服用している患者,原因不明の発熱の患者は,ヒストプラズマカプスラトゥーム感染の有無を評価する必要があります.
- 早期の診断と介入は,免疫不全の宿主における拡散性ヒストプラズモシスの管理に極めて重要です.
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