提出了芽生菌病的治疗指南;这些指南是代表美国国家过敏和传染病研究所真菌病研究小组和美国传染病学会的专家小组的共识。胚真菌病的临床范围是多种多样的,包括无症状感染,急性或慢性肺炎,和肺外疾病。大多数有芽生菌病的患者需要治疗。在某些具有免疫功能的急性肺胚菌病患者中可能会发生自发性治愈。因此,在疾病仅限于肺部的情况下,治愈可能发生在诊断之前,没有治疗;这样的患者应密切随访,以获得疾病进展或传播的证据。相比之下,所有免疫功能低下的患者,有进行性肺部疾病,或有肺外疾病必须治疗。治疗方案包括两性霉素B,酮康唑,伊曲康唑,和氟康唑.两性霉素B是免疫功能低下患者的首选治疗方法,患有危及生命或中枢神经系统(CNS)疾病,或者唑治疗失败的人。此外,两性霉素B是唯一被批准用于治疗孕妇芽生菌病的药物。唑类药物是两性霉素B的同等有效且毒性较低的替代品,用于治疗轻度至中度肺部或肺外疾病的免疫活性患者。排除中枢神经系统疾病。虽然没有比较试验,伊曲康唑似乎比酮康唑或氟康唑更有效。因此,伊曲康唑是治疗非危及生命的非中枢神经系统芽生菌病的首选药物。
Guidelines for the treatment of blastomycosis are presented; these
guidelines are the
consensus opinion of an expert panel representing the National Institute of Allergy and Infectious Diseases Mycoses Study Group and the Infectious Diseases Society of America. The clinical spectrum of blastomycosis is varied, including asymptomatic infection, acute or chronic pneumonia, and extrapulmonary disease. Most patients with blastomycosis will require therapy. Spontaneous cures may occur in some immunocompetent individuals with acute pulmonary blastomycosis. Thus, in a case of disease limited to the lungs, cure may have occurred before the diagnosis is made and without treatment; such a patient should be followed up closely for evidence of disease progression or dissemination. In contrast, all patients who are immunocompromised, have progressive pulmonary disease, or have extrapulmonary disease must be treated. Treatment options include amphotericin B, ketoconazole, itraconazole, and fluconazole. Amphotericin B is the treatment of choice for patients who are immunocompromised, have life-threatening or central nervous system (CNS) disease, or for whom azole treatment has failed. In addition, amphotericin B is the only drug approved for treating blastomycosis in pregnant women. The azoles are an equally effective and less toxic alternative to amphotericin B for treating immunocompetent patients with mild to moderate pulmonary or extrapulmonary disease, excluding CNS disease. Although there are no comparative trials, itraconazole appears more efficacious than either ketoconazole or fluconazole. Thus, itraconazole is the initial treatment of choice for nonlife-threatening non-CNS blastomycosis.