两例荚膜组织胞浆菌肺部感染患者诊治研究

Study on diagnosis and treatment of two cases of pulmonary infections caused by Histoplasma

目的探讨组织胞浆菌病实验室和临床诊治特点,为减少组织胞浆菌病的漏检率和病死率提供经验。方法调查两例由荚膜组织胞浆菌引起的肺组织胞浆菌病临床资料,分析其组织胞浆菌病患者流行病学史和治疗原则及疗效;采用萨布罗和血琼脂培养基进行病原菌培养。结果两例患者均为有组织胞浆菌暴露史的人群,两例患者伊曲康唑治疗约4个月后均有明显效果;该菌初代在萨布罗培养基真菌孵箱培养10d后,生长出微小、白色干燥菌落,血琼脂于普通孵箱20d后长出酵母样菌落;组织标本剪碎后涂片,六胺银染色查见真菌大分生孢子,有管型和柱型的突起;次代生长的菌落通过乳酸棉酚兰、革兰染色均见到典型的大分生孢子,>50%的大分生孢子表面有管型和柱型突起。结论组织胞浆菌培养困难和时间长,组织剪碎后涂片行六胺银染色镜下见真菌大分生孢子,有管型和柱型的突起,可以提前提示实验室内要考虑组织胞浆菌的培养和鉴定,医学实验室和临床均应高度重视患者的流行病史,提高组织胞浆菌的检出。

OBJECTIVE To explore the characteristics of laboratory and clinical diagnosis and treatment of histo- plasmosis so as to reduce the missing rate and mortality rate of the patients with histoplasmosis. METHODS The clinical data of two cases of h.istoplasmosis caused by Histoplasma were investigated, then the epidemiological his- tory and principles of treatment and efficacy of the patients with histoplasmosis were analyzed. Sabouraud medium （SDA） and blood agar medium were adopted for culture of pathogens. RESULTS Both patients had the history of exposure to the Histoplasrna. The treatment with itraconazole for 4 months could achieve significant effect. After the fist generation of Histoplasrna strains were cultured in fungal incubator of Sabouraud medium for 10 days, the tiny white dried colonies grew, and yeast-like colonies grew on blood agar in the common incubator with blood agar after the culture for 20 days. After the tissue samples were cut and stained, the methenamine silver staining showed the large spores of fungi, which had tube-type and column-type protuberances. The lactophenol cotton blue staining and gram staining showed typical large spores in the second generation of colonies, and more than 50 % of the typical large spores had tube-type and column-type protuberances. CONCLUSION The culture of Histoplasma is difficult and takes long time. The methenamine silver staining shows the large spores of fungi, which have tube- type and column-type protuberances, indicating the necessity to perform culture and identification of Histoplasma in the laboratory in early stage. The medical clinical laboratory should attach great importance to the epidemics his- tory of the patients and raise the isolation rate of Histoplasma.