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153
154 ∂¶πΔ√ª∏ ¶¡∂Àª√¡√§√°π∞
̇ÎËÙ·. ŒÙÛÈ, ÌÂÁ¿ÏÔ˜ ·ÚÈıÌfi˜ Ì˘Î‹ÙˆÓ ·Ó·Ù‡Û- ÚˆÛË ÚˆÙÔ·ıÔ‡˜ ÂÛÙ›·˜, Ë ÔÔ›· ›¯Â ıÂڷ¢-
ÛÔÓÙ·È Û ÔÚÓÈıÔÙÚÔÊ›·, Û ÛËÏȤ˜, Û ÎÔ˘Ê¿Ï˜ Ù›.
‰¤Ó‰ÚˆÓ Î·È Û ·Ï·È¿ Û›ÙÈ·.
∫ÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ
¶·ıÔÁ¤ÓÂÈ· ∏ Ó¢ÌÔÓÈ΋ ÈÛÙÔÏ¿Û̈ÛË Â›Ó·È Î·ÏÔ‹ı˘ Ófi-
OÈ ÛfiÚÔÈ ÙÔ˘ ̇ÎËÙ· ÂÈÛÓ¤ÔÓÙ·È Î·È ÚÔÛÏ·Ì- ÛÔ˜, ‰Â‰Ô̤ÓÔ˘ fiÙÈ ÙÔ 99% ÙˆÓ ·ÙfiÌˆÓ Ô˘ ÌÔχ-
‚¿ÓÔÓÙ·È ÛÙȘ ΢„ÂÏ›‰Â˜ ·fi Ù· Ì·ÎÚÔÊ¿Á·. ™ÙËÓ ÓÔÓÙ·È ·Ó·Ï·Ì‚¿ÓÔ˘Ó.
·Ú¯‹, ÂÂȉ‹ ‰ÂÓ ¤¯ÂÈ ·Ó·Ù˘¯ı› ΢ÙÙ·ÚÈ΋ ·ÓÔ- ΔȘ ÂÚÈÛÛfiÙÂÚ˜ ÊÔÚ¤˜ Ë ÓfiÛÔ˜ Â›Ó·È ·Û˘Ì-
Û›·, Ù· Ì·ÎÚÔÊ¿Á· ‰ÂÓ Â›Ó·È Â˘·ÈÛıËÙÔÔÈË̤ӷ و̷ÙÈ΋ Î·È Ë ·ÚÔ˘Û›· Ù˘ Û ¤Ó·Ó ÏËı˘ÛÌfi
Î·È ‰ÂÓ ÌÔÚÔ‡Ó Ó· ηٷÛÙÚ¤„Ô˘Ó ÙÔ˘˜ ̇ÎËÙ˜, Á›ÓÂÙ·È ·ÓÙÈÏËÙ‹ ·fi ÙËÓ ‡·ÚÍË ıÂÙÈÎÒÓ ‰ÂÚÌ·-
Ô˘ ÔÏÏ·Ï·ÛÈ¿˙ÔÓÙ·È Ì¤Û· Û’ ·˘Ù¿. Δ· Ì·ÎÚÔ- ÙÔ·ÓÙȉڿÛÂˆÓ ÈÛÙÔÏ·ÛÌ›Ó˘ Î·È È˙ËÌ·ÙÈÓÔ·ÓÙÈ-
Ê¿Á· ÌÂٷʤÚÔ˘Ó ÙÔ˘˜ ̇ÎËÙ˜ ÛÙÔ˘˜ ÏÂÌÊ·‰¤Ó˜ ‰Ú¿ÛˆÓ.
·ÏÏ¿ Î·È Û ¿ÏÏ· fiÚÁ·Ó· ÙÔ˘ ‰ÈÎÙ˘ÔÂÓ‰ÔıËÏÈ·ÎÔ‡ ∏ ÔÍ›· ÌÔÚÊ‹ ÂΉËÏÒÓÂÙ·È ÌÂ Û˘ÌÙÒÌ·Ù·
Û˘ÛÙ‹Ì·ÙÔ˜ (ÛÏ‹Ó·, ‹·Ú), fiÔ˘ Î·È ·Ó·Ù‡ÛÛÔ- Ô˘ ÌÔÈ¿˙Ô˘Ó Ì Ù˘ Áڛ˘. OÈ ·ÛıÂÓ›˜ ·ÚÔ˘ÛÈ-
ÓÙ·È ÂÛٛ˜ Ù˘ ÓfiÛÔ˘. ¿˙Ô˘Ó ˘ÚÂÙfi, Ì˘·ÏÁ›Â˜, ÍËÚfi ‚‹¯·. ∏ ÎÏÈÓÈ΋ Âͤ-
ŸÙ·Ó ·Ó·Ù˘¯ı› Ë Î˘ÙÙ·ÚÈ΋ ·ÓÔÛ›·, ÂÌÊ·Ó›- Ù·ÛË Â›Ó·È ·ÚÓËÙÈ΋ ‹ ˘¿Ú¯Ô˘Ó Ï›ÁÔÈ ÙÚ›˙ÔÓÙ˜.
˙ÔÓÙ·È ÛÙȘ ÂÚÈÔ¯¤˜ Ô˘ ˘¿Ú¯Ô˘Ó ÔÈ Ì‡ÎËÙ˜ ·Á- ™˘¯Ó¿ ·Ú·ÙËÚÂ›Ù·È Ô˙҉˜ Î·È ÔχÌÔÚÊÔ ÂÚ‡-
ÁÂÈ›Ùȉ· Ì ıÚÔÌ‚ÒÛÂȘ ·ÁÁ›ˆÓ Î·È ÙÔÈΤ˜ ÓÂ- ıËÌ·. ∏ ‰ÈfiÁΈÛË ÙˆÓ ˘Ï·›ˆÓ ÏÂÌÊ·‰¤ÓˆÓ ›ӷÈ
ÎÚÒÛÂȘ, ÁÂÁÔÓfi˜ Ô˘ ÚÔηÏ› Î·È ‰ÈfiÁΈÛË ÙˆÓ ‰˘Ó·Ùfi Ó· ÚÔηϤÛÂÈ ÈÂÛÙÈο Ê·ÈÓfiÌÂÓ·. ™¿-
ÏÂÌÊ·‰¤ÓˆÓ. ∏ ÏÂÌÊ·‰ÂÓ›Ùȉ·, ‡ÛÙÂÚ· ·fi 3-4 ÓÈ· Ë ÔÍ›· ÌÔÚÊ‹ ÂΉËÏÒÓÂÙ·È Ì ÙËÓ ÎÏÈÓÈ΋
Ì‹Ó˜, ˘Ô¯ˆÚ› Ì ÙËÓ ·Ó¿Ù˘ÍË ÎÔÎÎȈ̿وÓ, ÂÈÎfiÓ· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Ù˘ ÔÍ›·˜ ·Ó·Ó¢ÛÙÈ΋˜
›ÓˆÛ˘ Î·È Â·Û‚ÂÛÙÒÛˆÓ. ·Ó¿ÚÎÂÈ·˜, ȉ›ˆ˜ fiÙ·Ó ÙÔ ¿ÙÔÌÔ ¤¯ÂÈ ÂÈÛÓ‡ÛÂÈ
∞Ó ‰ÂÓ ·Ó·Ù˘¯ı› Ë Î˘ÙÙ·ÚÈ΋ ·ÓÔÛ›·, Ë ÏÔ›- ÌÂÁ¿ÏË ÔÛfiÙËÙ· Ì˘Î‹ÙˆÓ. ∏ ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·-
̈ÍË ‰ÂÓ ÂÚÈÔÚ›˙ÂÙ·È ÛÙÔ ‰ÈÎÙ˘ÔÂÓ‰ÔıËÏÈ·Îfi Û‡- ÎÔ˜ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi Ó¢ÌÔÓÈ΋ ‰È‹ıËÛË ÌÂ
ÛÙËÌ·, ·ÏÏ¿ ÂÍ·ÏÒÓÂÙ·È Û fiÏÔ ÙÔ ÛÒÌ·. ™Â ·ÓÔ- ·‰ÂÓ›Ùȉ· Î·È ·ÚÁfiÙÂÚ· Â›Ó·È ‰˘Ó·Ùfi Ó· ÂÌÊ·ÓÈ-
ÛÔηÙÂÛÙ·Ï̤ÓÔ˘˜ ·ÛıÂÓ›˜ Ë ÂͿψÛË Ù˘ Ófi- ÛÙÔ‡Ó Â·Û‚ÂÛÙÒÛÂȘ ÛÙÔ Ó¢ÌÔÓÈÎfi ·Ú¤Á¯˘Ì·,
ÛÔ˘ Â›Ó·È ‰˘Ó·Ùfi Ó· ÚÔÎÏËı› Î·È ·fi ·Ó·˙ˆ‡- ÛÙÔ˘˜ ÏÂÌÊ·‰¤Ó˜ Î·È ÛÙÔÓ ÛÏ‹Ó· (ÂÈÎ. 11.1).
∂ÈÎfiÓ· 11.1. ∞. √Í›· Ó¢ÌÔÓÈ΋ ÈÛÙÔÏ¿Û̈ÛË: ‰È¿¯˘Ù˜ ‚ÚÔÁ¯ÔÓ¢ÌÔÓÈΤ˜ ÂÛٛ˜ Î·È ÛÙÔ˘˜ ‰‡Ô Ó‡ÌÔÓ˜. ∂Ï·ÊÚ¿
‰ÈfiÁΈÛË ÙˆÓ ˘Ï·›ˆÓ ÏÂÌÊ·‰¤ÓˆÓ. μ. ⁄ÛÙÂÚ· ·fi ÌÂÚÈο ¯ÚfiÓÈ· ˘¿Ú¯Ô˘Ó ‰È¿Û·ÚÙ˜ ·ÔÙÈÙ·ÓÒÛÂȘ Î·È ÛÙÔ˘˜ ‰‡Ô
Ó‡ÌÔÓ˜.
11. ¶¡∂Àª√¡π∫∂™ ªÀ∫∏Δπ∞™∂π™ ∫∞π §√πªø•∂π™ ∞¶√ ¶∞ƒ∞™πΔ∞ 155
∂ÈÎfiÓ· 11.2. ÃÚÔÓ›· Ó¢ÌÔÓÈ΋ ÈÛÙÔÏ¿Û̈ÛË. ∞. ¢È‹ıËÛË Ô˘ ηٷϷ̂¿ÓÂÈ ÙÔÓ ‰ÂÍÈfi ¿Óˆ ÏÔ‚fi. μ. ⁄ÛÙÂÚ· ·fi 2 ¤ÙË
Ë ÓfiÛÔ˜ ¤¯ÂÈ ÂÚÈÔÚÈÛÙ› ÛÙË ‰ÂÍÈ¿ ÎÔÚ˘Ê‹ Á‡Úˆ ·fi ¤Ó· Û‹Ï·ÈÔ.
∏ ‰È¿ÁÓˆÛË ‰ÂÓ Â›Ó·È Â‡ÎÔÏË, ÁÈ·Ù› Ë ·ÔÌfi- Ì ηÎfiËı˜ ÓfiÛËÌ· ÙÔ˘ ·›Ì·ÙÔ˜, ÔÈ ÔÔ›ÔÈ ˘Ê›-
ÓˆÛË ÙÔ˘ ̇ÎËÙ· ÛÙ· Ù‡ÂÏ· ‰ÂÓ ÛËÌ·›ÓÂÈ Î·È ÚÔ- ÛÙ·ÓÙ·È ¯ËÌÂÈÔıÂڷ›·. ∏ ÓfiÛÔ˜ ÂΉËÏÒÓÂÙ·È ˆ˜
Û‚ÔÏ‹ ·fi ÙË ÓfiÛÔØ ·ÏÒ˜ Û˘¯Ó¿ ˘Ô‰ËÏÒÓÂÈ ·- Ó¢ÌÔÓ›·. ™ÙȘ ÂÚÈÙÒÛÂȘ ·˘Ù¤˜ ¤¯Ô˘Ó ÂÚÈÁÚ·-
ÔÈÎÈÛÌfi ÙˆÓ ·ÓÒÙÂÚˆÓ ·ÂÚÔÊfiÚˆÓ Ô‰ÒÓ. °È’ ·˘- Ê› Î·È Û˘ÛÙËÌ·ÙÈΤ˜ ÌÔÚʤ˜ Ù˘ ÓfiÛÔ˘ Ì ÚÔÛ-
Ùfi Â›Ó·È ·Ó·Áη›Ô Ó· Ï·Ì‚¿ÓÔÓÙ·È Ì ‚ÚÔÁ¯ÔÛÎfi- ‚ÔÏ‹ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜, ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡ Î·È ÙÔ˘
ËÛË Í¤ÛÌ·Ù· ‹ ‚ÈÔ„›Â˜ ‚ÚfiÁ¯ˆÓ ‹ Ó‡ÌÔÓ· Î·È ∫¡™.
Ë ·Ó·˙‹ÙËÛË ‹ Ë Î·ÏÏȤÚÁÂÈ· ÙÔ˘ ̇ÎËÙ· Ó· Á›ÓÂ- ∏ ‰È¿ÁÓˆÛË ÛÙËÚ›˙ÂÙ·È ÛÙËÓ ·Ó‡ÚÂÛË ÙˆÓ Ì˘-
Ù·È Û’ ·˘Ù¿ Ù· ˘ÏÈο. OÈ ÔÚÔÏÔÁÈΤ˜ ·ÓÙȉڿÛÂȘ Î‹ÙˆÓ Î·È Ë ıÂڷ›· Û˘Ó›ÛÙ·Ù·È ÛÙË ¯ÔÚ‹ÁËÛË
‰ÂÓ Â›Ó·È È‰È·›ÙÂÚ· ·ÍÈfiÈÛÙ˜. Amphotericin.
∏ ıÂڷ›· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙË ¯ÔÚ‹ÁËÛË Am-
photericin Î·È ÚÔÛ¿ıÂȘ ÁÈ· ÙË ‚ÂÏÙ›ˆÛË Ù˘ ªÔÓÈÏ›·ÛË (Candidiasis)
·ÈÌ·ÙÔÏÔÁÈ΋˜ ÂÈÎfiÓ·˜.
∏ ÓfiÛÔ˜ ÔÊ›ÏÂÙ·È ÛÙÔ Û·ÚfiÊ˘ÙÔ ˆ›‰ÈÔÓ ÙÔ Ï¢-
‰) ¶·Ú·ÚÈÓÔÎÔÏ›Ùȉ˜ ο˙ÔÓ (candida albicans) Î·È ÚÔηÏ› Û˘¯Ó¿ ‰ÂÚ-
Ì·ÙÈΤ˜ ‹ ÔÚÔÊ·Ú˘ÁÁÈΤ˜ ÏÔÈÌÒÍÂȘ. ™˘ÛÙËÌ·ÙÈ΋
™˘¯Ó‹ Â›Ó·È Ë ÈÁÌÔÚ›Ùȉ· Î·È Ë ÚÔÛ‚ÔÏ‹ ÙˆÓ Ëı-
ÌÔÓÈÏ›·ÛË Û˘Ì‚·›ÓÂÈ ÌfiÓÔ Û ·ÓÔÛÔηÙÂÛÙ·Ï̤ӷ
ÌÔÂȉÒÓ ÎfiψÓ. À¿Ú¯ÂÈ Î›Ó‰˘ÓÔ˜ ¤ÎÙ·Û˘ Ù˘
¿ÙÔÌ· Ì ÌÂÁ¿ÏË ÂÏ¿ÙÙˆÛË ÙˆÓ Ô˘‰ÂÙÂÚÔʛψÓ.
Ïԛ̈͢ ÛÙÔ ∫¡™. ∞·ÈÙÂ›Ù·È Ë ·ÚÔ¯¤Ù¢ÛË ÙˆÓ
™ÙÔ˘˜ ·ÛıÂÓ›˜ ·˘ÙÔ‡˜ Û˘Ó‹ıˆ˜ ‰È·ÎÚ›ÓÔ˘Ì ηÈ
ÎfiÏˆÓ Î·È Û˘ÛÙËÌ·ÙÈ΋ ıÂڷ›· Ì Amphote-
ÙËÓ ‡ÏË ÂÈÛfi‰Ô˘ ÙÔ˘ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡ (.¯. ÛÙÔ-
ricin.
Ì·ÙÈ΋ ‹ ‰ÂÚÌ·ÙÈ΋ ÌÔÓÈÏ›·ÛË).
Δ¤ÏÔ˜, Ú¤ÂÈ Ó· ˘ÂÓı˘Ì›ÛÔ˘Ì fiÙÈ Û ̇ÎËÙ˜
OÈ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ Ù˘ Û˘ÛÙËÌ·ÙÈ΋˜ ÌÔÓÈ-
ÙÔ˘ Á¤ÓÔ˘˜ ÙÔ˘ ·ÛÂÚÁ›ÏÏÔ˘ ÔÊ›ÏÂÙ·È Î·È Â͈ÁÂ-
Ó‹˜ ΢„ÂÏȉ›Ùȉ· (Ó¢ÌÔÓ›· ·fi ˘ÂÚ¢·ÈÛıË- Ï›·Û˘ ÂÍ·ÚÙÒÓÙ·È ·fi Ù· fiÚÁ·Ó· Ô˘ ÚÔÛ‚¿Ï-
Û›·), Ë ÔÔ›· ·Ó·Ù‡ÛÛÂÙ·È ÌÂÙ¿ ÙËÓ ÂÈÛÓÔ‹ ÙˆÓ ÏÂÈ, ·fi ÙËÓ ¤ÎÙ·ÛË Ù˘ ÚÔÛ‚ÔÏ‹˜ Î·È ·fi ÙËÓ
Ì˘Î‹ÙˆÓ ·fi ÌË ·ÓÔÛÔηÙÂÛÙ·Ï̤ӷ ¿ÙÔÌ·. ηٿÛÙ·ÛË ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡. ŸÙ·Ó ÚÔÛ‚¿ÏÏÂÙ·È Ô
Ó‡ÌÔÓ·˜, Ù· Û˘ÌÙÒÌ·Ù· Â›Ó·È Û˘Ó‹ıˆ˜ ‹È·,
ªÔ˘ÎÔÚÌ˘ÎËÙ›·ÛË ‹ Ê˘ÎÔÌ˘ÎËÙ›·ÛË ÂÓÒ ÛÙËÓ ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ ÂÌÊ·Ó›˙ÔÓÙ·È
(Mucormycosis ‹ Phycomycosis) Ó¢ÌÔÓÈΤ˜ ‰ÈËı‹ÛÂȘ.
∏ ÓfiÛÔ˜ ÔÊ›ÏÂÙ·È Û ÌÈ· ÔÌ¿‰· Ì˘Î‹ÙˆÓ Ô˘ ʤ- ∏ ‰È¿ÁÓˆÛË ··ÈÙ› ÙËÓ ·ÚÔ˘Û›· ÙÔ˘ ̇ÎËÙ·
ÚÂÙ·È Ì ÙÔ fiÓÔÌ· Mucoraceae. §Ô›ÌˆÍË Û˘Ì‚·›- Û ÈÛÙÔÏÔÁÈο ·Ú·Û΢¿ÛÌ·Ù· ‚ÈÔ„›·˜ Ó‡ÌÔ-
ÓÂÈ, fiÙ·Ó ·Ó·ÛÙ·Ï› Ë ÏÂÈÙÔ˘ÚÁ›· ÙˆÓ Ô˘‰ÂÙÂÚÔÊ›- ÓÔ˜. ∏ ·Ó¿Ù˘ÍË Ì˘Î‹ÙˆÓ Û ηÏÏȤÚÁÂÈ· ÛÙÔÌ·-
ÏˆÓ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ·ÓÔÛÔηٷÛÙÔÏ‹˜ ‹ ·fi ÙÔÊ·Ú˘ÁÁÈÎÒÓ ÂȯÚÈÛÌ¿ÙˆÓ ÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÊÔ-
۷ί·ÚÒ‰Ë ‰È·‚‹ÙË. ∏ ÔͤˆÛË Î·È Ë ·‡ÍËÛË ÙÔ˘ Ú¤˜ ˘Ô‰ËÏÒÓÂÈ ·ÏÒ˜ ÙÔÓ ·ÔÈÎÈÛÌfi Ù˘ ÂÚÈÔ-
۷ί¿ÚÔ˘ ·Ó·ÛÙ¤ÏÏÔ˘Ó ÙË ÏÂÈÙÔ˘ÚÁ›· ÙˆÓ Ô˘‰ÂÙÂ- ¯‹˜. ∞ÎfiÌË Î·È ıÂÙÈΤ˜ ·ÈÌÔηÏÏȤÚÁÂȘ ›ӷÈ
ÚÔʛψÓ. ‰˘Ó·Ùfi Ó· Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ·ÚÔ‰È΋˜ Ì˘ÎËÙ·È-
™Â ·ÛıÂÓ›˜ Ì ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË Ë ÓfiÛÔ˜ Ì›·˜.
ÚÔÛ‚¿ÏÏÂÈ ÙË Ì‡ÙË Î·È ÙÔÓ ÔÚÔÊ¿Ú˘ÁÁ· Î·È ·fi ∏ ıÂڷ›· Ù˘ Û˘ÛÙËÌ·ÙÈ΋˜ ÌÔÓÈÏ›·Û˘ ÂÈ-
ÂΛ ÂÂÎÙ›ÓÂÙ·È ÛÙÔ˘˜ ·Ú·ÚÚÈÓÈÎÔ‡˜ ÎfiÏÔ˘˜, Ù˘Á¯¿ÓÂÙ·È Ì ÙË ¯ÔÚ‹ÁËÛË Amphotericin ‹ 5-Fluo-
ÛÙȘ ÎfiÁ¯Â˜ ηÈ, ¤ÂÈÙ· ·fi ‰È¿‚ÚˆÛË ÙÔ˘ ÎÚ·Ó›- rocytocine ‹ Ketoconazole. π‰È·›ÙÂÚË ÛËÌ·Û›· ¤¯ÂÈ
Ô˘, ÛÙÔ ∫¡™. ™ÙÔ ÛÙfiÌ· ÂÌÊ·Ó›˙ÔÓÙ·È ¯·Ú·ÎÙËÚÈ- Î·È Ë ·ÓÙÈÌÂÙÒÈÛË Ù˘ ‰ÂÚÌ·ÙÈ΋˜ ‹ Ù˘ ÛÙÔÌ·ÙÈ-
ÛÙÈο Ì·‡Ú· ÂȯڛÛÌ·Ù·. ΋˜ ÌÔÓÈÏ›·Û˘, ÌÈ· Î·È ·˘Ù¤˜ ·ÔÙÂÏÔ‡Ó ÙȘ ‡Ï˜
∏ Ó¢ÌÔÓÈ΋ ÌÔÚÊ‹ ÂΉËÏÒÓÂÙ·È Û ·ÛıÂÓ›˜ ÂÈÛfi‰Ô˘ ÙˆÓ Ì˘Î‹ÙˆÓ.
μÈ‚ÏÈÔÁÚ·Ê›·
Drerzen S. Oral candidiasis. Am J Med 1984; 77: 28-39.
Drutz DJ, Catanzara A. Coccidioidomycosis (parts I and II): State of art. Am Rev Resp Dis 1978; 117: 559 & 727.
Editorial. Aspergillomas. Lancet 1983; 2: 1066-7.
Fraser DW, Word JL, et al. Aspergilosis and other systemic mycosis. JAMA 1979; 242: 631-5.
11. ¶¡∂Àª√¡π∫∂™ ªÀ∫∏Δπ∞™∂π™ ∫∞π §√πªø•∂π™ ∞¶√ ¶∞ƒ∞™πΔ∞ 159
Goodwin RA, Loyd JF, et al. Histoplasmosis in normal hosts. Medicine 1981; 60: 231-247.
Kerkering TM, et al. The evaluation of pulmonary cryptococcosis. Ann Inter Med 1981; 94: 611-23.
Kirkpatrick CH. Host factor in defence against funcal infection. Am J Med 1984; 77: 1-7.
Lehler RI, Howard DH, et al. Mucormycosis (UCLA conference). Ann Inter Med 1980; 93: 93-103.
Meyer RD, Armstrong D. MucÔrmycosis-changing status. CRC Crit Rev Clin Lab Sci 1973; 4: 421-52.
Ricketti AJ, Greenberger PA, et al. Allergic bronchopulmonary aspergillosis. Chest 1984; 86: 773-8.
Rohatgi PK, et al. Clinical spectrum of pulmonary aspergillosis. South Med J 1984; 77: 1291-9.
Sarosi GA, et al. Blastomycosis: state of art. Am Rev Resp Dis 1979: 120-411-35.
ÛÔ˘Ó ‰È·ÛÙ¿ÛÂȘ ÔÈ Ôԛ˜ Û˘Ó¿ÁÔÓÙ·È ¿ÛÎËÛË ÙËÓ ˘‰·Ú‹ Û‡ÛÙ·ÛË ÙÔ˘ ÂÚȯÔ̤ÓÔ˘ Ù˘ ·ÛÙ˘.
›ÂÛ˘ ÛÙÔ ›‰ÈÔ ÙÔ fiÚÁ·ÓÔ ‹ ÛÙÔ˘˜ Á‡Úˆ ·Ó·ÙÔÌÈ- ∏ ‰È¿ÁÓˆÛË ˘Ô‚ÔËıÂ›Ù·È ·fi ÙËÓ ·Ó¿Ù˘ÍË
ÎÔ‡˜ Û¯ËÌ·ÙÈÛÌÔ‡˜. ·ÓÙÈÛˆÌ¿ÙˆÓ ÛÙ· ·ÓÙÈÁfiÓ· ÙÔ˘ ˘‰·ÙȉÈÎÔ‡ ˘ÁÚÔ‡.
∏ Ú‹ÍË Ù˘ ·ÛÙ˘ ÛÙÔ˘˜ ‚ÚfiÁ¯Ô˘˜ ÚÔηÏ› ŒÙÛÈ, ÛÙÔ 80-85% ÙˆÓ ÂÚÈÙÒÛÂˆÓ Ë ‰ÂÚÌÔ·ÓÙ›-
‰‡ÛÓÔÈ·, ·ÈÌfiÙ˘ÛË ‹ Î·È ·Ô‚ÔÏ‹ ÙÔ˘ ÂÚȯÔ- ‰Ú·ÛË Casoni Â›Ó·È ıÂÙÈ΋. ΔÔ ÌÂÈÔÓ¤ÎÙËÌ· Â›Ó·È Ë
̤ÓÔ˘ Ù˘ ·ÛÙ˘. Œ¯Ô˘Ó ·Ú·ÙËÚËı› Î·È ·ÓÙÈ- ‡·ÚÍË ÛËÌ·ÓÙÈÎÔ‡ ·ÚÈıÌÔ‡ „¢‰Ò˜ ıÂÙÈÎÒÓ ·ÓÙÈ-
‰Ú¿ÛÂȘ ˘ÂÚ¢·ÈÛıËÛ›·˜. ∏ Ú‹ÍË ÛÙÔ˘˜ ‚ÚfiÁ¯Ô˘˜ ‰Ú¿ÛˆÓ. ∏ ·ÓÙ›‰Ú·ÛË Û‡Ó‰ÂÛ˘ ÙÔ˘ Û˘ÌÏËÚÒ-
¤¯ÂÈ ·ÔÙ¤ÏÂÛÌ· Î·È ÙË ‰È·ÛÔÚ¿ Ù˘ ÓfiÛÔ˘ Ì ÙËÓ Ì·ÙÔ˜ (R. Weinberg) Â›Ó·È ıÂÙÈ΋ ÙÔ˘Ï¿¯ÈÛÙÔÓ ÛÙÔ
·Ó¿Ù˘ÍË Ó¤ˆÓ ·ÛÙˆÓ. ™˘¯Ó¿, ¤ÂÈÙ· ·fi Ú‹ÍË, 75% ÙˆÓ ·ÛıÂÓÒÓ. Δ¤ÏÔ˜, ÌÂÁ·Ï‡ÙÂÚË Â›Ó·È Ë
ÔÈ ˘ÔÏÂÈÌÌ·ÙÈΤ˜ ÎÔÈÏfiÙËÙ˜ ‰È·˘˝ÛÎÔÓÙ·È Î·È Â˘·ÈÛıËÛ›· Î·È Ë ÂȉÈÎfiÙËÙ· Ù˘ ¤ÌÌÂÛ˘ ·ÈÌÔÛ˘-
ÚÔηÏÔ‡Ó ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ ·ÚfiÌÔȘ Ì ÙÔ˘ ÁÎfiÏËÛ˘ ÛÙË ‰È¿ÁÓˆÛË Ù˘ ÓfiÛÔ˘. O Û˘Ó‰˘·ÛÌfi˜
Ó¢ÌÔÓÈÎÔ‡ ·ÔÛÙ‹Ì·ÙÔ˜. ÙˆÓ ·ÓÔÛÔ‚ÈÔÏÔÁÈÎÒÓ ÌÂıfi‰ˆÓ ·˘Í¿ÓÂÈ ÙÔ ÔÛÔ-
ÛÙfi ÙˆÓ ‰È·ÁÓÒÛˆÓ.
¢È¿ÁÓˆÛË
Δ· Û˘ÌÙÒÌ·Ù· Î·È Ù· ÛËÌ›· Â›Ó·È ÂÏ¿¯ÈÛÙ·: Ë £Âڷ›· Î·È ÚfiÁÓˆÛË
Ú‹ÍË ÙˆÓ Î‡ÛÙÂˆÓ Î·È Ë ·Ô‚ÔÏ‹ ÙÔ˘ ÂÚȯÔ̤- ∏ ıÂڷ›· Ù˘ ¯ÈÓÔÎÔÎΛ·Û˘ Â›Ó·È ¯ÂÈÚÔ˘ÚÁÈ΋.
ÓÔ˘ ÙÔ˘˜ Â›Ó·È Û˘¯Ó¿ ‰È·ÁÓˆÛÙÈ΋. ™˘ÓÙËÚËÙÈ΋ ıÂڷ›· Ì Mebendazole ‹ Al-
∞ÎÙÈÓÔÏÔÁÈÎÒ˜ ÔÈ Î‡ÛÙÂȘ Û˘¯Ó¿ Â›Ó·È ÌÔÓ‹ÚÂȘ bendazole (400 mg οı 12 ÒÚ˜ ÁÈ· 4 ‚‰ÔÌ¿‰Â˜)
‹ ¿ÏÏÔÙ ˘¿Ú¯Ô˘Ó ÔÏϤ˜ ·ÛÙÂȘ ÛÙÔÓ ¤Ó·Ó ‹ Î·È ÂȯÂÈÚ›ٷÈ, fiÙ·Ó ˘¿Ú¯ÂÈ ‰È·ÛÔÚ¿ Ù˘ ÓfiÛÔ˘ ÛÂ
ÛÙÔ˘˜ ‰‡Ô Ó‡ÌÔÓ˜ (ÂÈÎ. 11.4μ). ∞Û‚ÂÛÙÔÔ›ËÛË ÔÏÏ¿ fiÚÁ·Ó· ‹ fiÙ·Ó ˘¿Ú¯Ô˘Ó ÛÙÔÓ Ó‡ÌÔÓ·
ÙÔ˘ ÙÔȯÒÌ·ÙÔ˜ ·Ú·ÙËÚÂ›Ù·È Î˘Ú›ˆ˜ ÛÙÔ ‹·Ú. ‰È¿Û·ÚÙ˜ ÔÏϤ˜ ·ÛÙÂȘ Ô˘ ‰ÂÓ ÌÔÚÔ‡Ó Ó·
ŸÙ·Ó ÔÈ Î‡ÛÙÂȘ ‰È·ÚÚ·ÁÔ‡Ó, ÂÌÊ·Ó›˙Ô˘Ó ÌÈ· ÛÙÈ- ·Ê·ÈÚÂıÔ‡Ó ¯ÂÈÚÔ˘ÚÁÈÎÒ˜.
‚¿‰· ·¤Ú· Î·È ‰›ÓÔ˘Ó ¯·Ú·ÎÙËÚÈÛÙÈ΋ ·ÎÙÈÓÔÏÔÁÈ- ™Ù· Ï·›ÛÈ· Ù˘ ‰ËÌfiÛÈ·˜ ˘ÁÈÂÈÓ‹˜ Ë ·ÓÙÈÌÂÙÒ-
΋ ÂÈÎfiÓ· (ÂÈÎ. 11.4∞). ÈÛË Ù˘ ÂͿψÛ˘ Ù˘ ÓfiÛÔ˘ ÛÙÚ¤ÊÂÙ·È ÚÔ˜
∏ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· Â›Ó·È ¯Ú‹ÛÈÌË È‰›ˆ˜ ÛÙË ÙÚÂȘ ηÙ¢ı‡ÓÛÂȘ:
‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË Ù˘ ¯ÈÓÔÎÔÎΛ·Û˘ ·fi fi- 1. ¶ÚÔ˜ ÙÔÓ ÔÚÈÛÙÈÎfi ÍÂÓÈÛÙ‹ (Û·ÏÔ) Ì ·fiÂÈ-
ÁÎÔ˘˜ ÙÔ˘ Ó‡ÌÔÓ·, ÂÂȉ‹ Ì·˜ ÏËÚÔÊÔÚ› ÁÈ· Ú˜ Ê·Ú̷΢ÙÈ΋˜ ··ÏÏ·Á‹˜ ÙÔ˘ ·fi ÙÔ ·-
∂ÈÎfiÓ· 11.4. ¶Ó¢ÌÔÓÈ΋ ¯ÈÓÔÎÔÎΛ·ÛË. ∞. ªÔÓ‹Ú˘ ·ÛÙË Ô˘ ¤¯ÂÈ Ú·Á› Î·È ·ÚÔ˘ÛÈ¿˙ÂÈ ÂÈÎfiÓ· “·Ó·Ù¤ÏÏÔÓÙÔ˜ ËÏ›Ô˘”
(‚¤ÏÔ˜). μ. ¶ÔÏϷϤ˜ ·ÛÙÂȘ ¯ÈÓÔÎfiÎÎÔ˘.
11. ¶¡∂Àª√¡π∫∂™ ªÀ∫∏Δπ∞™∂π™ ∫∞π §√πªø•∂π™ ∞¶√ ¶∞ƒ∞™πΔ∞ 163
μÈ‚ÏÈÔÁÚ·Ê›·
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Barrett-Conner E. Parasitic pulmonary disease. Am Rev Resp Dis 1982; 126: 558-63.
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