组织胞浆菌病7例分析及文献复习

A report of seven cases of histoplasmosis and literature review

目的分析组织胞浆菌病的临床特点、治疗和转归,加深对该病的认识。方法回顾性分析2001—2014年上海华山医院收治的7例组织胞浆菌病,并总结中国大陆同期发表的组织胞浆菌病文献共549例病例资料。结果播散型组织胞浆菌病的主要表现包括发热、肝脾肿大、浅表及深部淋巴结肿大、血细胞减少等,伴HIV/AIDS者血细胞减少及皮肤黏膜表现突出。局灶性感染者缺乏系统性受累的症状或体征。组织学检查可见巨噬细胞内吞噬的荚膜组织胞浆菌。治疗多用两性霉素B,轻症患者予以伊曲康唑。结论组织胞浆菌病是由荚膜组织胞浆菌引起的深部真菌感染,病原菌培养阳性是诊断的金标准,需及时送检标本;治疗以两性霉素B为主,可辅以伊曲康唑。

Objective To describe the clinical feature ,therapeutic approach and prognosis of histoplasmosis for improving clinicians’ awareness of this disease .Methods The clinical data of 7 cases of histoplasmosis treated in Shanghai Huashan Hospital from 2001 to 2014 were reviewed retrospectively .Relevant reports about histoplasmosis from 2001 to 2014 in Chinese mainland were comprehensively reviewed .Results The major clinical manifestations of progressive disseminated histoplasmosis included fever ,hepatosplenomegaly ,lymphadenopathy ,and pancytopenia .Skin lesions and pancytopenia were more common in the patients complicated with HIV/AIDS .The patients with local infection were lack of systemic symptoms or signs . Histological examination found Histoplasmacapsulatum in macrophages in bone marrow or biopsy tissues .Amphotericin B was used most frequently to treat histoplasmosis .Itraconazole was appropriate in mild patients .Conclusions Histoplasmosis is caused by H .capsulatum .The golden standard of diagnosis is any culture positive for H .capsulatum .Antifungal treatments such as amphotericin B and itraconazole are very important .