28例免疫功能基本正常儿童肺隐球菌病的临床特征及流行病学调查

Clinical characteristics and epidemiological investigation of pulmonary cryptococcosis in 28 children with basically normal immune function

目的探讨免疫功能基本正常儿童肺隐球菌病的临床特征及流行病学特征。方法选取2015年1月—2022年9月湖州及周边地区医院的28例免疫功能基本正常儿童肺隐球菌病患者为研究对象,收集所有患儿临床资料,回顾性分析临床特征、影像学表现及预后情况。结果在入组的28例患儿中,男孩19例(67.9%),女孩9例(32.1%);年龄1~3岁7例(25.0%),3~6岁8例(28.6%),>6岁13例(46.4%)。临床症状表现以咳嗽为主,有14例(50.0%),其次为恶心呕吐8例(28.6%)、高热6例(21.4%),无症状的患者有8例(28.6%)。不同性别、不同年龄阶段患儿的临床症状表现比较差异无统计学意义(P>0.05)。影像学形态特征分析显示,入组的28例患儿中,病灶形态为单发型13例(46.4%)、多发型8例(28.6%)、混合型2例(7.1%)、肺炎型5例(17.9%)。单发型病灶影像学征象以边缘平直征(13例,100.0%)、晕轮征(11例,84.6%)、胸膜凹陷征(7例,53.8%)为主,多发型病灶影像学征象以蘑菇兄弟征(6例,75.0%)、晕轮征(5例,62.5%)及边缘平直征(4例,50.0%)为主,肺炎型病灶影像学征象以支气管充气征(5例,100.0%)为主。不同形态特征病灶的边缘平直征、晕轮征、蘑菇兄弟征、支气管充气征比较差异有统计学意义(P<0.05)。肺隐球菌病患儿可疑环境接触史以鸽子(10例,35.7%)、宠物或家禽(6例,21.4%)为主,其次为可疑土壤(3例,10.7%)和鸟禽类粪便(2例,7.1%)。实验室检测结果显示,免疫功能基本正常的肺隐球菌病患儿存在明显的CRP升高(20例,71.4%)和血沉异常(11例,39.3%)。25例均完成治疗,有14例接受氟康唑治疗,8例接受伏立康唑治疗,3例接受两性B霉素+氟胞嘧啶+氟康唑序贯治疗,3例患者未接受治疗,仅随访观察。不同治疗方式对肺隐球菌病的治疗有效率和疾病控制率比较差异无统计学意义(P>0.05)。结论肺隐球菌病可发生于免疫功能基本正常、无可疑环境接触史的儿童,但临床症状表现无明显特异性,需要借助影像学检查、实验室检查进行辅助诊断。

Objective To explorethe clinical and epidemiological characteristics of pulmonary cryptococcosis in children with normal immune function.Methods 28 children with pulmonary cryptococcosis with basically normal immune function in Hospitals in Huzhou and surrounding areas from January 2015 to September 2022 were selected as the study subjects,and the clinical data of all children were collected,and the clinical characteristics,imaging manifestations and prognosis were retrospectively analyzed.Results Among the 28 enrolled children,19 were boys(67.9%)and 9 were girls(32.1%);7 cases(25.0%)were aged from 1 to 3 years,8 cases(28.6%)were aged from 3 to 6 years,and 13 cases(46.4%)were older than 6 years.The clinical symptoms were mainly cough in 14 cases(50.0%),followed by nausea and vomiting in 8 cases(28.6%),high fever in 6 cases(21.4%),and asymptomatic patients in 8 cases(28.6%).There was no significant difference in clinical symptoms among children of different genders and ages(P>0.05).The analysis of imaging morphological characteristics showed that among the 28 children enrolled in the study,13 cases(46.4%)were single type,8 cases(28.6%)were multiple type,2 cases(7.1%)were mixed type,and 5 cases(17.9%)were pneumonia type.The imaging signs of single type focus mainly included straight edge sign(13 cases,100.0%),halo sign(11 cases,84.6%),pleural indentation sign(7 cases,53.8%).The imaging signs of multiple type focus mainly included mushroom brother sign(6 cases,75.0%),halo sign(5 cases,62.5%),and straight edge sign(4 cases,50.0%).The imaging signs of pneumonia type focus mainly included bronchial inflation sign(5 cases,100.0%).There were statistically significant differences in the edge straight sign,halo sign,mushroom brother sign and bronchial inflation sign of lesions with different morphological characteristics(P<0.05).The suspected environmental exposure history of children with pulmonary cryptococcosis was mainly pigeons(10 cases,35.7%),pets or poultry(6 cases,21.4%),followed by suspected soil(3 cases,10.7%)and bird feces(2 cases,7.1%).The laboratory test results showed that the children with pulmonary cryptococcosis with basically normal immune function had significantly elevated CRP(20 cases,71.4%)and abnormal ESR(11 cases,39.3%).All 28 patients completed the treatment,14 patients received fluconazole treatment,8 patients received voriconazole treatment,3 patients received amphotericin+flucytosine+fluconazole sequential treatment,3 patients did not receive treatment,only followed up.There was no significant difference in the treatment efficiency and disease control rate of pulmonary cryptococcosis between different treatment methods(P>0.05).Conclusion Pulmonary cryptococcosis can occur in children with basically normal immune function and no history of suspicious environmental exposure,but the clinical symptoms are not obviously specific,which requires the assistance of imaging examination and laboratory examination.