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Abstract：
Coccidioidomycosis is endemic to California, Arizona, and Mexico. In recent years, the reported cases of coccidioidomycosis have increased in nonendemic regions. Here, we reported a case of imported pulmonary coccidioidomycosis in a Chinese patient. A 63-year-old man presented with dry cough and fatigue for 6 months, and a computed tomography scan revealed a solitary nodule in the right lower lung and small nodules in both lungs. The diagnosis of coccidioidomycosis was initially confirmed by histopathologic examination. The pathogen Coccidioides spp. was identified by laser capture microdissection (LCM) combined with subsequent molecular techniques based on the positive histopathologic features. Additionally, we reviewed 47 reported cases of coccidioidomycosis in China. The number of reported cases is increasing, and the incidence of disseminated infection has exhibited a trend of shifting towards healthy young adults in China. Since clinical presentations and imaging findings lack specificity, a majority of domestic cases of coccidioidomycosis were initially misdiagnosed as tumours or tuberculosis. Moreover, the diagnosis of endemic mycoses may be challenging because of their rarity and the limited availability of diagnostic tests. The diagnosis was mainly confirmed by histopathological examination. The species involved were identified based on positive cultures in only 4 cases. To our knowledge, this is the first study to use LCM and molecular techniques to identify Coccidioides spp. in the histopathologically positive but uncultivable specimen. Comparing with previous reported studies, LCM combined with nucleic acid amplification techniques improve the ability of species identification for the timely diagnosis of coccidioidomycosis.
摘要：
球孢子菌病是加州特有的,亚利桑那,和墨西哥。近年来,在非流行地区，报告的球孢子菌病病例有所增加。这里,我们报道了一例中国患者的输入性肺球孢子菌病。一名63岁的男子出现干咳和疲劳6个月，计算机断层扫描显示右下肺有孤立结节，双肺有小结节。球孢子菌病的诊断最初通过组织病理学检查得到证实。病原体球虫属。根据阳性组织病理学特征，通过激光捕获显微解剖（LCM）结合随后的分子技术进行鉴定。此外,我们回顾了中国报道的47例球孢子菌病病例。报告的病例数量不断增加,在中国，播散性感染的发病率呈现出向健康的年轻人转移的趋势。由于临床表现和影像学表现缺乏特异性，大多数国内的球孢子菌病病例最初被误诊为肿瘤或肺结核。此外，地方性真菌病的诊断可能具有挑战性,因为它们的稀有性和诊断测试的可用性有限.诊断主要通过组织病理学检查证实。仅在4例病例中基于阳性培养物鉴定了所涉及的物种。据我们所知,这是首次使用LCM和分子技术鉴定球虫的研究。在组织病理学上呈阳性但无法培养的标本中。与以前报道的研究相比，LCM结合核酸扩增技术提高了菌种鉴定能力，可及时诊断球孢子菌病。
