我国部分地区组织胞浆菌感染的流行病学调查

Study on epidemiology of histoplasma capsulatum infection in China

目的 :组织胞浆菌病是一种地方性真菌病。我国的自然条件适宜于组织胞浆菌生长与传播 ,但缺乏组织胞浆菌感染的流行病学资料。本研究目的是调查我国组织胞浆菌感染的流行情况。 方法 :30 0例正常人和 4 35例住院患者分别来源于湖南、江苏和新疆维吾尔自治区。前臂皮内注射酵母相组织胞浆菌素 (HIS ,美国ALK/Berke leyBiologicalsLaboratories生产 )和人型 结核菌素纯蛋白衍生物 (PPD) ,4 8～ 72h观察结果 ,最大红肿硬结直径≥ 5mm为阳性。 结果 :18.8% (138/ 735 )受试者HIS皮试阳性 ,阳性反应直径为 5 .0～ 4 5 .0 (9.1± 4 .3)mm。湖南、江苏和新疆三地正常人组HIS皮试阳性率有显著差异 ,分别为 8.9%、15 .1%和 2 .1% (P <0 .0 5 ,P <0 .0 1)。患者组HIS总阳性率为 2 5 .5 % ,明显高于相应地区正常人组 (P <0 .0 1)。肺结核患者阳性率为 31.7% (78/ 2 4 6 ) ,高于肺炎 17.7% (11/ 6 2 )、肺癌 2 0 .9% (9/ 4 3)、慢性阻塞性肺病 (COPD) 17.3% (9/ 5 2 )和其他疾病 12 .5 % (4 / 32 ) (P <0 .0 1)。PPD总阳性率为 5 2 .0 % (2 92 / 5 6 2 ) ,阳性反应直径为 5 .0～ 5 0 .0 (13.7± 4 .9)mm。两种抗原皮试均阳性者11.2 % ,均阴性者 4 2 .9% ,HIS皮试阳性而PPD阴性者 6 .8%。 结论 :我国存在组织胞浆?

Objectives: The worldwide distribution of infection with Histoplasma capsulatum in the America and other foreign countries has been reported. However, no reliable information exists concerning the presence or absence of this infection in the People's Republic of China. Thus, the object of our study was to provide data concerning this question. Methods:300 normal people and 435 hospitalized patients lived in Hunan province, Jiangsu province, and Xinjiang municipality respectively were tested with yeast phase histoplasmin (ALK/Berkeley Biologicals Laboratories, USA) and PPD on the volar surface of the forearm. Any reaction to the antigens of 5.0mm in diameter of induration at 48-72 hours was considered positive. Results:138/735(18.8%) subjects reacted to histoplasmin with 5.0-45.0(9.1±4.3)mm induration. Significant differences of positive skin reaction rate of normal subjects were found among Hunan, Jiangsu, and Xinjiang (8.9% vs 15.1% vs 2.1%). The total positive rate of patients was 25.5 %. The patients with tuberculosis 〔31.7% (78/246)〕 had significantly higher positive skin reaction rate in comparison with pneumonia 〔 17.7 % (11/62)〕, lung cancer 〔20.9% (9/43)〕, COPD 〔17.3% (9/52)〕 and other diseases 〔12.5% (4/32)〕, ( P <0.01). Of 562 cases, 292 cases ( 52.0 %) reacted to PPD with indurations of 5-50(13.7±4.9)mm in diameter. 63 cases (11.2%) reacted to both histoplasmin and PPD, while 38 cases (6.9%) reacted to histoplasmin but not to PPD. Conclusions: The data suggests that there is H. capsulatum herd infection in P.R.China, the infection rate in the southeast China is higher than in the northwest, and the infection rate of the patients with pulmonary tuberculosis is higher than normal persons and other pneumonopathy patients.