肺吸虫病误诊为结核病原因分析

Analysis of causes of paragonimiasis misdiagnosed as tuberculosis

目的通过对肺吸虫病误诊为结核病的病例的原因进行分析,以减少误诊率。方法对2005年1月—2011年5月重庆市公共卫生医疗救治中心收治的15例肺吸虫病例的一般资料、临床表现、影像学检查、实验室检查进行分析。结果入选患者15例,其中误诊为结核病12例,男性6例,女性6例,年龄20-38岁。12例患者入院前均被误诊为结核病,包括肺结核、结核性胸膜炎、结核性心包炎及结核性脑膜炎,均进行了胸部X线摄片检查或CT检查,均有胸腔积液或胸膜增厚,在痰中及体液中均未找到抗酸杆菌,血清肺吸虫抗体,均呈阳性反应,经吡喹酮治疗后,体温恢复正常或其他症状明显好转。其中10例有明确的生食溪蟹或生水的经历,胸痛11例,发热和咳嗽各10例。白细胞增高有10例,嗜酸性细胞分类增高11例。结论明确的生食溪蟹或生水的经历、嗜酸性细胞增高及影像学表现为游走性病灶对诊断该肺吸虫病有高度提示意义,再将临床表现和其他实验室检查结合起来综合分析,可以减少误诊。

Objective Through analyzing the causes of paragonimiasis misdiagnosed as tuberculosis to reduce the rate of misdiagnosis. Methods Totally 15 paragonimiasis patients in Chongqing Public Health Medical Treatment Center from January 2005 to May 2011 were analyzed through the general information, clinical manifestations, imaging, and laboratory tests. Results Selected 15 patients, of which 12 cases misdiagnosed as tuberculosis, 6 males, 6 females, aged 20 -38 years old. 12 patients were misdiagnosed as tuberculosis, including lung tuberculosis, tuberculous pleurisy, tuberculous pericarditis and tuberculous meningitis before admission, underwent a chest X - ray examination or CT scan, all have been found pleural effusion or pleural thickening, acid -fast bacilli was not found in sputum and body fluids, paragonimiasis serum antibodies were positive reaction, after praziquantel treatment, body temperature returned to normal, or other symptoms improved markedly. In 12 patients, 10 cases of a clear raw crabs or raw water experience, 11 cases of chest pain, 10 cases of fever and cough, 10 cases of white blood cells increased and 11 cases of eosinophils classified increased. Conclusions Raw crabs or raw water experience, increased eosinophils and imaging in the diagnosis of migratory lesions of the lung fluke disease is highly suggestive, then a comprehensive analysis of the clinical manifestations and other laboratory tests together can reduce misdiagnosis.