经尸检证实的儿童深部真菌感染18例

Autopsyconfirmed deep fungal infection in children: analysis of 18 cases

目的 了解 1983年 2月～ 1999年 10月 ,北京儿童医院尸体检查 (尸检 )病例深部真菌感染检出情况及其临床特点。方法 10 0 0例尸检病例 ,其中深部真菌感染者 18例。病理诊断根据HE染色和特殊染色 ,显微镜下见器官或组织中有真菌菌丝或孢子。结果 尸检病例中深部真菌感染总检出率为 1.8% (18/10 0 0 ) ;1997年以前的病例共 13例 ,占尸检总数 1.4% (13/96 4) ,1997年以来共5例 ,占尸检总数 14% (5 /36 )。在 18例中 ,病理检查提示单个器官受累的有 7例 ,两个以上器官受累的共 11例。所见真菌种类主要有曲霉菌、念珠菌及毛霉菌 ,分别为 11例、5例和 2例。 18例中 ,16例资料记录完整 ,临床诊断败血症 7例 ,肺炎 8例 ,肺结核 2例 ,以及迁延性腹泻、泛发性湿疹、恶性肿瘤、获得性自身免疫性溶血性贫血等。 16例中出现过发热者 12例次 ,3例次体温不升 ;呼吸道受累的11例中 ,6例次有咳嗽 ,8例次有气促及肺部音 ;消化道受累的 8例有呕吐、排稀水便、黑便等 ;3例次脑受累的病例有 2例有惊厥发作。 16例均应用了抗生素 ,其中 13例使用 3种以上 ;有 11例用过地塞米松、泼尼松等皮质类固醇激素 ;有 2例使用了化疗药物。住院过程中怀疑过真菌感染的 4例 ,只有 2例用过抗真菌药。

Objective In recent years, the morbidity of deep mycosis has been increasing, the mortality and the rate of misdiagnosis were high. The present study aimed at understanding the clinical and pathological characteristics of deep fungal infection in autopsy confirmed cases in our hospital.Methods Between Feb.1983 and Oct.1999, 18 cases with deep mycosis were identified out of 1 000 consecutive necropsies. Pathologic diagnosis was made based on hematoxillin and eosin (HE) and special stainings such as PAS and hexamine silver. Under the microscope, the hyphae and/or spores could be seen in various tissues. In addition, the authors also reviewed the clinical records. Results The total rate of autopsy detection of deep mycosis was 1.8% (18/1 000); it was 1.4% (13/964) between Feb.1983 and Dec.1996; but during recent 3 years, it increased to 14% (5/36). During the same periods, the numbers of the patients with Cryptococcal meningitis which were diagnosed by ink stain of cerebrospinal fluid were 13 and 8, respectively. Necropsies of the 18 cases indicated that only one organ was affected in 7 cases, whereas 2 or more organs were affected in 11 cases. The species of fungi included Aspergillus, Candida, and mucormycosis; they were identified in 12 cases, 5 cases, 1 case, respectively. Pulmonary involvement was reported in 14 case, followed by the gastrointestinal (8/18), kidney (7/18), liver (6/18), spleen (5/18), brain (5/18) and various other organs. Sixteen cases had complete records, their initial clinical diagnoses included sepsis (7), pneumonia (8), tuberculosis (2) malignancy, et al. The clinical manifestations included fever, cough, dyspnea, vomiting, diarrhea and seizure. All the 16 cases were treated with antibiotics; 13 of them were treated with more than 3 antibiotics. Dexmathesone or prednisone was used in 11 cases and chemotherapy was applied for 2 cases. Four cases were suspected of having systemic mycosis during the clinical course; only 2 of them were treated with antifungal drugs. Conclusions The morbidity of deep mycosis has been increasing in recent years. The conditions known to predispose deep mycosis included cytotoxic drugs, corticosteriods, prolonged antibiotic administration or severe underlying diseases. The lung was the most commonly affected organ. The yield of fungal culture was low. Since diagnosis of deep mycosis is usually difficult, more alertness and frequent diagnostic assessment are important for finding the problem early.