8例组织胞浆菌病临床特征分析并文献复习

Clinical characteristics of histoplamosis in 8 patients: case report and literature review

为探讨组织胞浆菌病(histoplasmosis,HP)的临床特点、影像学表现和诊疗方法,以提高该疾病的诊治率,回顾性分析了中南大学湘雅二医院2004年至2014年经病理组织学确诊的8例住院HP患者的临床资料。8例HP患者的临床表现主要有发热、咳嗽、咳痰、胸痛、痰中带血、淋巴结肿大等;肺部影像学表现主要为团块状、结节样或肺炎型改变。无1例患者首诊考虑肺部真菌病。4例表现为局灶肺部病变的患者均采用手术切除,3例患者采用两性霉素脂质体、伏立康唑、伊曲康唑抗真菌治疗,均获有效治疗。HP的临床症状及影像学表现无特异性,易误诊为细菌感染、肺癌、结核、淋巴瘤等,早期积极地多次多部位的病理活检联合多次病原学检查对提高疾病的诊断率和预后有重要的意义。

To explore the clinical characteristics, imaging manifestatioN, diagnosis and treatment for histoplasmosis and to improve therapeutic level, we retrospectively analyzed the clinical data of 8 patients with biopsy-confirmed histoplasmosis from 2004 to 2014 in the Second Xiangya Hospital of Central South University and reviewed relevant literatures. The main clinical symptoms of histoplasmosis included fever, cough, expectoration, chest pain, blood-stained sputum, lymphadenectasis, etc. The major lung imaging features were mass, node or pneumonia- like performance. No case was diagnosed as histoplasimosis firstly. Four patients whose imaging manifestations were focal pulmonary lesion received lobectomy of lung lesions or wedge resection. Clinical and imaging manifestations in 3 patients, who treated with amphotericin B or its liposomal, itraconazole or fluconazole, were improved. The clinical symptoms and imaging findings of histoplasmosis are nonspecific. It is easy for the physicians to misdiagnose histoplasmosis as bacterial infection, lung cancer, tuberculosis lymphoma, etc. Therefore, it is significant and necessary to carry out multiple biopsies combined with multiple etiological examinations for patients with difficult diagnosis.