肺并殖吸虫病临床误诊分析

Analysis of Clinical Misdiagnosis of Pulmonary Paragonimiasis

目的 探讨肺并殖吸虫病的临床特点、诊断和鉴别诊断措施,以及误诊原因、防范措施。方法 对2013年1月—2022年8月收治的曾误诊的肺并殖吸虫病4例的临床资料进行回顾性分析。结果 本组临床表现为发热、咳嗽、血痰、咯血,咳嗽、咳痰、腹痛,咳嗽、气促,以及反复左下胸部疼痛各1例;3例呼吸音粗,2例可闻及湿性啰音;外周血嗜酸粒细胞均明显升高,红细胞沉降率均增快;胸部CT检查均可见肺部病变。本组曾在外院误诊为肺结核2例,肺嗜酸粒细胞性肉芽肿和肿瘤各1例。误诊时间2~144个月。据病史及肝吸虫IgG抗体阳性等确诊2例,经肺泡灌洗液宏基因二代测序和病理检查确诊各1例。4例确诊后给予吡喹酮治疗临床症状均好转。结论 肺并殖吸虫病临床易误诊。接诊医生应全面采集病史并提高对该病的认识和警惕性,以减少或避免误诊误治。

Objective To investigate the clinical features,diagnosis,differential diagnosis,causes of misdiagnosis and preventive measures of pulmonary paragonimiasis.Methods The clinical data of 4 patients with pulmonary paragonimiasis who had been misdiagnosed from January,2013 to August,2022 were retrospectively analyzed.Results The clinical manifestations were fever,cough,bloody sputum,and hemoptysis in 1 case,cough,sputum,and abdominal pain in 1 case,cough and shortness of breath in 1 case,and repeated pain in the left lower chest in 1 case.There were 3 cases with coarse breathing sound and 2 cases with audible moist rales.Eosinophils in peripheral blood increased significantly,and erythrocyte sedimentation rate increased rapidly.Chest CT examination showed lung lesions.In this group,2 cases were misdiagnosed as pulmonary tuberculosis,1 case as eosinophilic granuloma and 1 case as tumor in other hospitals.Misdiagnosis lasted from 2 to 144 months.According to the history and positive liver fluke IgG antibody,2 cases were confirmed,and 1 case was confirmed by the second generation sequencing and pathological examination of alveolar lavage fluid.All 4 cases were treated with Praziquantel after diagnosis.Conclusion Pulmonary paragonimiasis is more likely to be misdiagnosed in clinical practice.In order to reduce or avoid misdiagnosis and treatment,the attending physician should take a comprehensive history and improve the awareness and vigilance of the disease.