Practice guidelines for the management of patients with histoplasmosis
Practice guidelines for the management of patients with histoplasmosis
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DOI：
10.1086/313752
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发表时间：
2000-04-01
影响因子：
11.8
通讯作者：
Kauffman, C
中科院分区：
文献类型：
--
作者：
Wheat, J;Sarosi, G;Kauffman, C
目标。本指南的目的是为治疗更常见的组织浆菌病提供建议。参与者和共识过程。召集了一个由该领域8名专家组成的工作组来制定这一准则。工作组通过一系列电话会议制定并完善了指南。治疗的目标是在可能的情况下根除感染，尽管对于艾滋病和其他严重的免疫抑制疾病患者，慢性抑制可能是足够的。其他重要的结果是临床异常的解决和复发的预防。本文对组织胞浆菌病的治疗进行了综述。针对慢性肺组织胞浆菌病和播散性组织胞浆菌病的治疗进行了对照试验。但临床经验和描述性研究为推荐其他形式的组织浆菌病提供了基础。根据为制定实践指南而建立的惯例，根据支持治疗建议的证据的强度分配价值，将最高价值分配给对照试验。收益和成本。某些形式的组织胞浆菌病可导致危及生命的疾病，并导致相当高的发病率，而其他表现则不会引起症状或轻微的自限性疾病。组织浆菌病的非进行性形式。然而。可降低功能能力，影响工作能力和生活质量达数月之久。对于进行性组织浆菌病（如慢性肺部感染或播散性感染）的患者，治疗显然是有益且具有成本效益的。目前尚不清楚治疗是否能改善自限性患者的预后，因为尚未对这一患者群体进行研究。其他慢性进行性组织浆菌病对药物治疗没有反应。治疗方案。组织胞浆菌病的治疗方案包括酮康唑、伊曲康唑、氟康唑。两性霉素B(真菌素；Bristol-Meyer Squibb；普林斯顿大学。NJ)，两性霉素B脂质体（AmBisome; Fujisawa, Deerfield， IL），两性霉素B胶体悬浮液（ABCD，或Amphotec: Seques， Menlo Park）。CA)和两性霉素B脂质复合物（ABLC，或Abelcet：脂质体）。普林斯顿,纽约)。
Objective. The objective of this guideline is to provide recommendations for treating patients with the more common forms of histoplasmosis.Participants and consensus process. A working group of 8 experts in this field was convened to develop this guideline. The working group developed and refined the guideline through a series of conference calls.Outcomes. The goal of treatment is to eradicate: the infection when possible, although chronic suppression may be adequate for patients with AIDS and other serious immunosuppressive disorders. Other important outcomes are resolution of clinical abnormalities and prevention of relapse.Evidence. The published literature on the management of histoplasmosis was reviewed. Controlled trials have been conducted that address the treatment of chronic pulmonary and disseminated histoplasmosis. but clinical experience and descriptive studies provide the basis for recommendations for other forms of histoplasmosis.Value. Value was assigned on the basis of the strength of the evidence supporting treatment recommendations, with the highest value assigned to controlled trials, according to conventions established for developing practice guidelines.Benefits and costs. Certain forms of histoplasmosis cause life-threatening illnesses and result in considerable morbidity, whereas other manifestations cause no symptoms or minor self-limited illnesses. The nonprogressive forms of histoplasmosis. however. may reduce functional capacity, affecting work capacity and quality of life for several months. Treatment is clearly beneficial and cost-effective for patients with progressive forms of histoplasmosis, such as chronic pulmonary or disseminated infection. It remains unknown whether treatment improves the outcome for patients with the self-limited manifestations, since this patient population has not been studied. Other chronic progressive forms of histoplasmosis are not responsive to pharmacologic treatment.Treatment options. Options for therapy for histoplasmosis include ketoconazole, itraconazole, fluconazole. amphotericin B (Fungizone; Bristol-Meyer Squibb. Princeton. NJ), liposomal amphotericin B (AmBisome; Fujisawa, Deerfield, IL), amphotericin B colloidal suspension (ABCD, or Amphotec : Seques, Menlo Park. CA), and amphotericin B lipid complex (ABLC, or Abelcet: Liposome. Princeton, NJ).