述评:从10年文献数据谈放线菌病的误诊概况及研究进展

The General Situation and Research Progress about the Misdiagnosis of Actinomycosis

放线菌是兼有细菌、革兰阳性菌和真菌特性的原核生物,由其引起的慢性化脓性肉芽肿性疾病统称为放线菌病,好发于颈面部及胸腹部,进展缓慢,以伴有瘘管及硫黄样颗粒脓液等为特征。放线菌病起病隐匿,临床表现无特异性,早期诊断困难。2004—2013年发表在中文医学期刊并经遴选纳入误诊疾病数据库的放线菌病误诊文献15篇,累计误诊病例38例,延误诊断时间6~15年,误诊病种17种,较多误诊为慢性扁桃体炎和肺部恶性肿瘤,经验不足而缺乏对该病的认识是最主要误诊原因。提示从生物学基础加强对放线菌病的认识,是避免误诊误治的关键。

Actinomyces is a filamentous prokaryotes with the some characteristics of Gram-positive bacteria and fungi.The chronic suppurative granulomatous disease caused by actinomyces is called the actinomycosis, which frequently occurs in the face-neck and chest-abdomen with the slow progress and the features of fistula, sulfur granule and so on.It is very difficult to diagnose earlier due to its insidious onset and no specific clinical manifestations.There were 15 papers published in Chinese medical journals about actinomycosis misdiagnosed from 2004 to 2013 in the selected misdiagnosed diseases database.In which, the total of 38 misdiagnosed cases were with the diagnosis delay from 6 to 15 years, the misdiagnosed diseases were 17 kinds and the frequently misdiagnosed diseases were chronic tonsillitis and malignant tumor of the lungs, and the lack of experience and short of the awareness for actinomycosis were the main causes of misdiagnosis.That suggested the strengthening understanding of actinomycosis from the basis of biology be the key to avoid misdiagnosis and mistreatment.