输入性球孢子菌肺部感染的临床分析及治疗

Clinical analysis and medical treatment of imported coccidioidomycosis

目的报告1例输入性球孢子菌肺部感染及皮肤感染患者的临床特点及治疗经过。方法回顾性分析1例输入性球孢子菌病患者的病例资料,阅读分析相关文献,探讨该疾病的临床特征。结果患者于外院及入院后反复予以多种抗细菌药物治疗,肺内病灶持续进展;每次随访炎症标志物及IgE无明显下降,进一步完善支气管镜检查,非组织真菌涂片见少量细长样菌丝,血培养及巧克力平板常温培养见丝状菌落生长;结合患者美国西部旅游史,考虑球孢子菌感染,应用大剂量氟康唑治疗后好转。结论对于起病前有美国西部地区驻留史的患者,临床应当考虑球孢子菌感染的可能性,治疗首选大剂量氟康唑。

OBJECTIVE To analyze the clinical data of 1 case of patient with imported Coccidioides pulmonary and skin infection and medical treatment and explore the etiology, clinical manifestations, diagnosis and treatment of the disease in combination with literatures. METHODS The medical data of 1 patient with imported coccidioidomycosis were retrospectively analyzed, the related literatures were reviewed, and the clinical features of the disease were explored. RESULTS The lung lesions continued to progress after multiple courses of antibacterial medications were performed before transferring to the hospital and after the admission. The follow-ups showed that the inflammatory markers and IgE were not reduced remarkably, and bronchoscopy was conducted, few slender-like hyphae were found to grow on the fungal smears, and filamentous colonies were seen to grow on blood culture and chocolate agar plate. The patient was considered as coccidioidomycosis according to the history of travelling to western part of the United States, and his condition was improved after treatment with large doses of fluconazole. CONCLUSION For patients with a history of residence in the western United States before onset, the possibility of Coccidioides infection should be considered in clinic, and high dose fluconazole is the first choice for treatment.