肺粪类圆线虫重症感染2例并文献复习

Review of 2 cases of severe infection with pulmonary Strongyloides stercoralis

目的:提高对肺粪类圆线虫感染的认识。方法:分析湖南省湘雅医院呼吸ICU确诊的2例肺粪类圆线虫重度感染患者的临床表现、实验室检测、影像学及病理学资料,并复习1973年至2013年国内报道的87个案例。结果:本次发现的2例患者均为消化道症状起病,仅在肺发现粪类圆线虫。89例死亡病例血常规检测中有嗜酸性粒细胞(EOS)的13例,其中10例EOS≤0.05×109/L。结论:农民为主要感染者。患有基础疾病或长期接受糖皮质激素治疗使机体免疫低下的患者感染粪类圆线虫后容易发展成重症感染致死。患者EOS减少提示预后较差,需早期诊断和治疗。

Objective: To improve the understanding of pulmonaryStrongyloides stercoralis. Methods: Two paients were diagnosed with severe infection with pulmonaryStrongyloides stercoralis by respiratory ICU of Xiangya Hospital. The clinical manifestations, laboratory tests, imaging and pathological data were analyzed. Another 87 cases in the literature were reviewed from 1973 to 2013. Results: In the 2 cases, digestive symptoms were the ifrst symptom andStrongyloides stercoralis was found in the lungs. Eosinophils was detected in the 13 death cases by blood routine examination, with 10 cases≤0.05×109/L. Conclusion: The farmers were the main infected people. Patients with basic diseases or with immunosuppression due to long-term glucocorticoid treatment tend to infect and even die atfer the infection withStrongyloides stercoralis. Eosinophil granulocyte reduction shows poor prognosis, which needs early diagnosis and treatment.