南方医科大学学报 ›› 2013, Vol. 33 ›› Issue (02): 296-.

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病理确诊的组织胞浆菌病:附14例分析

孟莹,蔡绍曦,李旭   

  • 出版日期:2013-02-20 发布日期:2013-02-20

Pathologically confirmed histoplasmsis: analysis of 14 cases

  • Online:2013-02-20 Published:2013-02-20

摘要: 目的收集南方医科大学南方医院2000~2012年组织胞浆菌病患者的既往史、临床表现、辅助检查结果、诊断、治疗及转归
情况,总结分析,以求提高组织胞浆菌病确诊率。方法选择医院2000~2012年经病理活检确诊的14例组织胞浆菌病病例进行
回顾性分析。结果组织胞浆菌病临床表现主要为发热、咳嗽、咳痰、胸痛、腹痛等,可合并神经系统症状或出现淋巴结肿大、体
表包块。7/14的患者具有基础免疫受抑疾病,9/14出现胸部影像学改变,2/14出现三系减少。确诊前诊断考虑结核、恶性肿瘤、
恶性淋巴瘤等疾病,最后均经病理活检确诊。治疗上选择伊曲康唑、两性霉素B、氟康唑及伏立康唑等,治疗后9/10好转。结论
组织胞浆菌病发病率低,临床表现多样,影像学特异性不高,极易误诊、漏诊,确诊需靠病原学检查,在诊断后治疗效果不佳时要
积极寻找有无潜在疾病,达到确诊目的。

Abstract: Objective To summarize the features of disease history, clinical manifestations, adjuvant examination results,
diagnosis, treatments and outcome of patients with histoplasmosis. Methods The clinical data of 14 patients with
biopsy-confirmed histoplasmosis between 2000 and 2012 in Nanfang Hospital were analyzed retrospectively. Results The
clinical manifestations of histoplasmosis included fever, productive cough, chest pain, and abdominal pain, accompanied
occasionally by neurological symptoms, lymph node enlargement or surface mass. Seven out of the 14 o patients had
underlying immunosuppressive conditions, 9 had chest imaging changes, and 2 showed reduced white blood cells, red blood
cells and platelets. The cases were initially diagnosis as tuberculosis, malignant tumor, or malignant lymphoma before the
definite diagnosis was established pathologically. Ten patients received treatments with itraconazole, amphotericin B,
fluconazole or voriconazole, and 9 of them responded favorably to the treatments. Conclusion Histoplasmosis, with a low
incidence and diverse clinical manifestations, presents with no specific imaging features to easily cause misdiagnosis and
missed diagnosis, and its definite diagnosis relies on pathological examination.