无基础疾病的肺真菌病16例临床分析

Clinical analysis of 16 cases of pulmonary mycosis in patients without underlying disease

目的探讨无基础疾病的肺真菌病临床表现,为其诊治提供依据。方法回顾性分析2009年1月—2013年8月确诊为无基础疾病的肺真菌病16例患者的临床、影像学及实验室检查特点。结果 16例确诊患者主要是肺曲霉病(9例)和肺念珠菌病(3例),分别占56.3%和18.7%,均无全身性疾病即原发病变的基础。临床主要表现为咳嗽、发热、咯血、呼吸困难;影像学主要表现为双肺多发斑片影、结节影或弥漫病变,容易误诊为肺结核或肺炎。16例患者中经支气管镜肺活检确诊2例,CT引导下经皮肺穿刺活检确诊12例,手术切除标本确诊2例。结论无基础疾病患者肺真菌病以曲霉病和肺念珠菌病为主,临床表现和影像改变无特异性,容易误诊为肺结核或肺炎,需及时行肺穿刺活检或支气管镜检查明确诊断。

Objective The clinical manifestations of pulmonary mycosis in the immunocompetent patients without underlying disease were analyzed to provide evidence for appropriate management of such patients.Methods The clinical characteristics,results of imaging and laboratory tests were retrospectively reviewed for 16 patients with pulmonary mycosis treated in our hospital from January 2009 to August 2013.Results Nine（56.3%）of the 16 patients were infected with pulmonary aspergillosis,and 3（18.7%）with pulmonary moniliasis.All the patients did not have any underlying disease.No specific clinical manifestation was identified.The main symptoms included cough,fever,hemoptysis,and dyspnea.Multiple patchy or nodular densities and diffuse lesions were the primary findings of imaging examination,which may lead to misdiagnosis as pulmonary tuberculosis or pneumonia.The diagnosis was confirmed by transbronchial lung biopsy in 2 cases,by CT-guided percutaneous lung biopsy in 12 cases,and by examination of resected tissue sample in 2 cases.Conclusions The pulmonary mycosis in patients without underlying disease is mainly pulmonary moniliasis or aspergillus. The mycosis is easily misdiagnosed as pulmonary tuberculosis or pneumonia due to the nonspecific clinical findings.Percutaneous lung biopsy or transbronchial lung biopsy is necessary to confirm the diagnosis in time.