放线菌病临床特征及诊断分析

Analysis of Clinical Features and Diagnosis of Actinomycosis

目的探讨放线菌病的疾病类型以及肺放线菌病的临床表现、影像学表现及诊断,以提高临床医师对放线菌病的诊治水平。方法回顾性分析2009年1月至2022年12月福建省立医院病理诊断、涂片或培养发现放线菌的病例33例的疾病类型,临床症状、影像学表现及诊断方法。结果面颈部疾病22例,胸部病例9例,其中肺放线菌病7例,腹部及其他部位病例各1例,其中定植病例为21例(63.6%),致病病例为12例(36.4%)。在肺放线菌病例中,发现肺放线菌男性比例明显高于女性,临床症状无特异性,可表现为咳嗽(29.4%)、咳痰(17.6%)、发热(23.5%)、咯血(17.6%)、胸痛(11.8%)。影像学表现中发现大部分可表现为中心低密度灶(16.7%)和空洞气泡征(20.8%)。诊断方法以组织病理诊断为主(57.1%)。结论放线菌病可发生在人体的任何部位,其中面颈部、胸部最常见。在肺放线菌病患者中,临床表现缺乏特异性,胸部CT表现多可出现中心低密度坏死灶,以及典型“空洞-悬浮气泡征”。放线菌培养难度大,诊断大多需要靠组织病理诊断。因此对于怀疑放线菌感染,建议获取组织病理活检结果。

Objective Improving the diagnosis and treatment level of clinicians by analyzing the types of actinomycosis and the clinical manifestations,imaging manifestations and diagnosis of pulmonary actinomycosis.Methods The disease types,clinical symptoms,imaging findings and diagnostic methods of 33 cases of actinomyces detected by pathological diagnosis,smear or culture in Fujian Provincial Hospital from January 2009 to December 2022 were retrospectively analyzed.Results There were 22 cases of facial and neck diseases,9 cases of chest diseases,7 cases of pulmonary actinomycosis,1 cases of abdominal and other parts of the case,among which 21 cases(63.6%)were colonized,12 cases(36.4%)were pathogenic.In the cases of pulmonary actinomyces,the proportion of male was significantly higher than female,and the clinical symptoms were non-specific,including cough(29.4%),sputum(17.6%),fever(23.5%),hemoptysis(17.6%),chest pain(11.8%).Most of the radiographic findings showed central low-density foci(16.7%)and hollow bubble sign(20.8%).The main diagnostic methods were histopathological diagnosis(57.1%).Conclusion Actinomycosis can occur in any part of human body,among which facial-neck regions and chest are the most common.In patients of pulmonary actinomycosis,there is a lack of clinical specificity,and chest imaging findings often include a central low-density necrotic focus and a typical“vacuum-suspended bubble sign”.The culture of actinomycetes is difficult,and most of the diagnosis needs to rely on histopathologic diagnosis.Therefore,it is recommended to obtain histopathological biopsy when we suspect infection with actinomycetes.