- 期刊
Non-endemic Pulmonary Coccidioidomycosis in Taiwan-A Case Report
在台灣地區非地方性之肺部球孢子菌感染－病歷報告
摘要
球孢子菌感染是一種經由在土壤裡的雙形性黴菌”Coccidioides immitis”所造成之感染，這種感染盛行於美國的西南區域。大多數原發性肺部球孢子菌感染的病人是沒有症狀的，目前唯一確定的感染模式是經由散佈於土壤內的黴菌孢子。 在非盛行區域，常因沒有想到這個疾病而沒有診斷出來。我們要報導一個在台灣這個非盛行區域，以肺部腫塊來表現的球孢子菌感染病例。這個病例因為反覆的肺部切片都顯示為壞死性肉芽組織發炎，所以剛開始是以抗結核菌藥物治療。最後經由開胸手術進行右中肺葉楔形切除後，才確定診斷為球孢子菌感染。 在這篇病例報告裡，我們也回顧了一些文章，關於球孢子菌感染的流行病學，臨床表現，診斷與治療。
並列摘要
Coccidioidomycosis is a dustborne infection caused by the dimorphic fungus Coccidioides immitis. Infections are endemic to certain regions of the southwestern United States. Most patients with primary pulmonary coccidioidomycosis are asymptomatic. Inhalation of fungal spores is the only established mode of infection, and spores may be carried on dust particles. Coccidioidomycosis is frequently unrecognized as a diagnosis because of the lack of suspicion in a non-endemic area. We described a case of coccidioidomycosis manifesting as a persistent pulmonary mass and diagnosed in Taiwan, a non-endemic area. This patient initially was treated with anti-tuberculosis drugs owing to the presence of necrotizing granulomatous inflammation on repetitive lung biopsies. The diagnosis of coccidioidomycosis was confirmed after wedge resection of the right middle lobe of the lung through minithoracotomy. We also reviewed the related literature concerning the epidemiology, clinical manifestations, diagnosis and treatment of coccidioidomycosis.