Zusammenfassung
Die Kokzidioidomykose ist eine inhalativ erworbene Systemmykose, die in wüstenähnlichen Gebieten im Südwesten der USA und benachbarten Regionen endemisch vorkommt, jedoch aufgrund der hohen Reiseaktivität zunehmend in anderen Regionen der Welt gesehen wird. Das klinische Spektrum ist breit und reicht von inapparenten Infektionen über Symptome eines akuten respiratorischen Infektes mit Spontanheilung bis zu Manifestationen einer disseminierten Kokzidioidomykose. Da die Mehrheit der Patienten mit disseminierter Kokzidioidomykose kutane Manifestationen aufweist, ist die frühzeitige Diagnose dieser potenziell lebensbedrohlichen Erkrankung durch den Dermatologen relevant. Hinweise auf eine Kokzidioidomykose sind atypische Hautveränderungen, pulmonale Infiltrate und eine entsprechende Reiseanamnese. Pathognomonisch ist der histologische, immunhistochemische und kulturelle Erregernachweis in läsionalem Gewebe. Mykoserologische Untersuchungen sind für Diagnosestellung und Verlaufskontrollen hilfreich. Die orale Azoltherapie mit Itraconazol 400 mg täglich 6 Monate über die klinische Abheilung hinaus gilt derzeit als Behandlung der 1. Wahl bei der kutanen Kokzidioidomykose. Häufige Rückfälle nach Absetzen der Therapie erfordern jahrelange klinische, mykoserologische und ggf. radiologische Kontrolluntersuchungen.
Abstract
Coccidioidomycosis is a systemic mycosis that is acquired by inhalation. It is endemic in desert-like areas of the southwest USA and neighboring regions, but is becoming increasingly prevalent in other regions of the world as a result of widespread travel. The clinical spectrum is broad, ranging from inapparent infections or symptoms of acute respiratory infection with spontaneous recovery to various manifestations of disseminated coccidioidomycosis. Since the majority of patients with disseminated coccidioidomycosis present with cutaneous manifestations, early diagnosis of this potentially life-threatening disease by dermatologists is important. Atypical skin changes, pulmonary infiltrates and a history of travel to areas where the disease is endemic are indicative of coccidioidomycosis. For conclusive diagnosis, identification of the fungus by histopathologic examination or culture is desirable. Serological tests can be helpful for establishing the diagnosis and monitoring the course of the disease. The treatment of choice for cutaneous coccidioidomycosis is currently oral azole antifungal agents, such as itraconazole 400 mg daily, continued for 6 months after clinical response. Since relapses are frequent after discontinuation of the treatment, close clinical, serological and radiological follow-up is required for years.
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Wir danken Herrn Dr. John N. Galgiani, Valley Fever Center for Excellence, Tucson, Arizona 85723 USA, für zahlreiche wertvolle Hinweise bei der Betreuung unserer beiden Patienten.
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Herrn Prof. Dr. med. Gernot Rassner zum 70. Geburtstag.
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Meier, F., Tintelnot, K., Metzler, G. et al. Kokzidioidomykose. Hautarzt 55, 1143–1149 (2004). https://doi.org/10.1007/s00105-004-0782-8
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DOI: https://doi.org/10.1007/s00105-004-0782-8