在旅行回来多年后呈现的型菌病
Koos Korsten1, Josje Altenburg2, Marieke Gittelbauer1
1Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, Amsterdam Medisch Centrum, Meibergdreef 9, Amsterdam, the Netherlands.
一名荷兰男子在前往加利福尼亚后出现了持续的呼吸道症状,被诊断出患有Coccidioides感染. 用可纳进行的抗真菌治疗成功清除了真菌感染,解决了他的症状.
科学领域:
- 医学真菌学 医学真菌学
- 传染性疾病 传染性疾病
- 肺部病理学 肺部病理学
背景情况:
- 型菌是一种流行于美国西南部的真菌感染,但可能发生在从流行地区返回的旅行者身上.
- 咳和呼吸短促等呼吸道症状可能是侵入性真菌感染的迹象.
- 过敏性支气管肺性阿斯伯吉洛症 (ABPA) 与其他肺性真菌感染具有一些临床和放射性特征.
研究的目的:
- 报告一个从加利福尼亚返回的旅行者感染Coccidioides的病例.
- 为了突出诊断挑战和传播的Coccidioidomycosis的治疗.
- 强调在有相关旅行史和持久性呼吸道症状的患者中考虑流行性真菌菌的重要性.
主要方法:
- 临床表现和病史审查.
- 对肺部异常进行放射性成像 (胸部X射线,CT扫描).
- 实验室检查包括IgE水平,埃索诺菲利亚和来自支气管支气管洗 (BAL) 的真菌培养.
- 抗真菌敏感性测试和治疗药物监测.
主要成果:
- 一名26岁的荷兰男子在访问加利福尼亚三年后出现了持续的咳和呼吸障碍.
- 放射学揭示了囊性支气管病变和巩固. 实验室测试显示IgE升高,埃索诺菲利亚,以及对Coccidioides的阳性BAL培养物.
- 怀疑ABPA的伊特拉科纳初始治疗失败;症状和培养物持续存在.
- 随后的6个月的弗卢可纳疗程成功地根除了Coccidioides感染.
结论:
- 肺部感染的差异诊断中,应考虑菌菌症,在有往往前往特有地区旅行的个人中.
- 准确和及时的诊断对于有效的治疗至关重要,因为最初的表现可以模仿其他疾病,如ABPA.
- 可纳是一种有效的治疗选择,可用于Coccidioidomycosis,即使在对其他抗真菌剂耐药的情况下.
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