弓形虫病临床误诊现状分析

Current status of toxoplasmosis misdiagnosis in clinic

为了解弓形虫病临床误诊现状,检索并整理2000年1月至2018年8月PubMed和清华同方CNKI数据库收录的国内外弓形虫病的临床误诊病例,对患者误诊的疾病类型、病变部位、确诊方法、是否合并感染艾滋病、器官移植接受情况等信息进行分析,探讨可能的误诊原因。共获得弓形虫病误诊相关文献70篇,累计误诊病例数251例。文献结果显示,弓形虫病患者的误诊疾病类型共61种,误诊病例数居前的2类疾病分别是虹膜睫状体炎(29例,占11.6%)、视网膜炎(22例,占8.8%)。脑、眼、肝等部位发病的病例数较多,分别为84 例(占34.2%)、64例(占26.0%)和31例(占12.6%)。132例患者经血清学方法诊断为弓形虫抗体阳性;68例患者(含25例死亡病例)经组织病理学检查,可见弓形虫滋养体或包囊;13例患者经血液、体液、穿刺液涂片镜检方法查见弓形虫。49例患者出现艾滋病合并感染症状。13例患者接受过骨髓移植,2例患者接受过肾移植。

To understand the current status of Toxoplasmosis misdiagnosis in clinic, information for the misdiagnosed Toxoplasmosis were collected by searching through PubMed and Tsinghua Tongfang CNKI database from January 2000 to August 2018 and analyzed regarding the type of diseases to which the Toxoplasmosis was misdiagnosed, the location of the infection and lesion, the method of definitive diagnosis, co-infection with HIV and organ transplantation. The possible causes for the misdiagnosis were further discussed. Total 70 related literatures were obtained and a total of 251 misdiagnosed cases were collected. The analytic results showed that Toxoplasmosis was misdiagnosed to 61 different types of diseases. The top two misdiagnosed diseases were iridocyclitis(11.6%, 29/251)and retinitis(8.8%, 22/251) in eyes. The most common locations of the infection and lesion were in brain(33.5%,84/251), eye(25.5%, 64/251) and liver(12.4%, 31/251). 132 cases were positive for Toxoplasma antibody by serological test;68 cases(including 25 death cases) were observed with Toxoplasma gondii trophozoites or cysts in tissues by histopathological examination;13 cases were diagnosed by identification of T. gondii in blood, body fluid and puncture fluid under microscope. Out of the total 251 misdiagnosed Toxoplasmosis, 49 had co-infection with HIV with symptoms of AIDS, 13 had received bone marrow transplantation and 2 received kidney transplantation.