Abstract：
Coccidioidomycosis is caused by the dimorphic fungi Coccidioides species which is endemic in the Western hemisphere. Reports on the characteristics of travel-related disseminated coccidioidomycosis in immunocompetent patients are rare, especially in non-endemic regions. The multifaceted symptoms of this condition present a diagnostic challenge to clinicians. This study aimed to review immunocompetent patients diagnosed with disseminated coccidioidomycosis in a tertiary hospital in Eastern China and other non-endemic areas, and to emphasize the importance of combining travel history with clinical manifestations and proper diagnostic examinations. This study retrospectively reviewed a case series of disseminated coccidioidomycosis diagnosed in an academic hospital in Eastern China. We conducted a global literature review of disseminated coccidioidomycosis in immunocompetent patients with travel history. We identified six patients in our case series and reviewed 42 cases in the literature. Travel history included Mexico, Arizona, California, and regions of low endemicity. Extrapulmonary sites of infection, which presented with diverse signs and symptoms, involved the skin and soft tissue, musculoskeletal system, lymph nodes, and central nervous system. Misdiagnoses and diagnostic delays were common. Next-generation sequencing substantially promoted precise diagnosis in our series. The overall prognosis for immunocompetent individuals was positive, mainly benefited from long-term azole therapies. The patients that succumbed had either central nervous system involvement or multiorgan dissemination. Progressive pneumonia with varied symptoms and travel history should alert healthcare professionals in non-endemic areas to consider the possibility of Coccidioides species infection. We recommend detailed history-taking and hypothesis-free detection of pathogens for cases with diagnostic delay.
摘要：
球孢子菌病是由西半球特有的双态真菌球孢子菌种引起的。关于免疫功能正常的患者中旅行相关的播散性球孢子菌病的特征的报道很少，特别是在非流行地区。这种情况的多方面症状对临床医生提出了诊断挑战。这项研究旨在回顾在中国东部和其他非流行地区的三级医院诊断为播散性球虫病的免疫功能正常的患者。并强调将旅行史与临床表现和适当的诊断检查相结合的重要性。这项研究回顾了在中国东部一家学术医院诊断的一系列播散性球虫菌病病例。我们对有旅行史的免疫功能正常患者的播散性球孢子菌病进行了全球文献综述。我们在我们的病例系列中确定了6例患者，并回顾了文献中的42例。旅行历史包括墨西哥，亚利桑那,加州,和地方性低的地区。肺外感染部位，表现出不同的体征和症状，涉及皮肤和软组织，肌肉骨骼系统,淋巴结,和中枢神经系统。误诊和诊断延迟很常见。下一代测序大大促进了我们系列中的精确诊断。免疫功能正常个体的总体预后为阳性，主要受益于长期的唑类药物治疗。死亡的患者有中枢神经系统受累或多器官播散。具有不同症状和旅行史的进行性肺炎应提醒非流行地区的医疗保健专业人员考虑球虫感染的可能性。对于诊断延迟的病例，我们建议详细的病史记录和无假设的病原体检测。
