Zhang Yan, Su Xiaoli, Li Yuanyuan, He Ruoxi, Hu Chengping, Pan Pinhua
Department of Respirotory Medicine, Xiangya Hospital, Central South University/ Key Cite of National Clinical Research Center for Respiratory Disease, Changsha 410008, China.
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2016 Dec 28;41(12):1345-1351. doi: 10.11817/j.issn.1672-7347.2016.12.016.
To compare clinical features, diagnosis and therapeutic effect between pulmonary histoplasmosis and progressive disseminated histoplasmosis. Methods: A retrospective analysis for 12 cases of hospitalized patients with histoplasmosis, who was admitted in Xiangya Hospital, Central South University during the time from February 2009 to October 2015, was carried out. Four cases of pulmonary histoplasmosis and 8 cases of progressive disseminated histoplasmosis were included. The differences of clinical features, imaging tests, means for diagnosis and prognosis were analyzed between the two types of histoplasmosis. Results: The clinical manifestations of pulmonary histoplasmosis were mild, such as dry cough. However, the main clinical symptoms of progressive disseminated histoplasmosis were severe, including recurrence of high fever, superficial lymph node enlargement over the whole body, hepatosplenomegaly, accompanied by cough, abdominal pain, joint pain, skin changes, etc.Laboratory examination showed pancytopenia, abnormal liver function and abnormal coagulation function. One pulmonary case received the operation of left lower lung lobectomy, 3 cases of pulmonary histoplasmosis and 6 cases of progressive disseminated histoplasmosis patients were given deoxycholate amphotericin B, itraconazole, voriconazole or fluconazole for antifungal therapy. One disseminated case discharged from the hospital without treatment after diagnosis of histoplasmosis, and 1 disseminated case combined with severe pneumonia and active tuberculosis died ultimately. Conclusion: As a rare fungal infection, histoplasmosis is easily to be misdiagnosed. The diagnostic criteria depends on etiology through bone marrow smear and tissues biopsy. Liposomeal amphotericin B, deoxycholate amphotericin B and itraconazole are recommended to treat infection for histoplasma capsulatum.
比较肺组织胞浆菌病和进行性播散性组织胞浆菌病的临床特征、诊断及治疗效果。方法：对2009年2月至2015年10月在中南大学湘雅医院住院的12例组织胞浆菌病患者进行回顾性分析。其中肺组织胞浆菌病4例，进行性播散性组织胞浆菌病8例。分析两种类型组织胞浆菌病在临床特征、影像学检查、诊断方法及预后方面的差异。结果：肺组织胞浆菌病临床表现较轻，如干咳。而进行性播散性组织胞浆菌病主要临床症状较重，包括高热反复、全身浅表淋巴结肿大、肝脾肿大，伴有咳嗽、腹痛、关节痛、皮肤改变等。实验室检查显示全血细胞减少、肝功能异常及凝血功能异常。1例肺部病例接受了左下肺叶切除术，3例肺组织胞浆菌病患者和6例进行性播散性组织胞浆菌病患者给予去氧胆酸盐两性霉素B、伊曲康唑、伏立康唑或氟康唑进行抗真菌治疗。1例播散性病例诊断为组织胞浆菌病后未治疗出院，1例播散性病例合并重症肺炎及活动性肺结核最终死亡。结论：组织胞浆菌病作为一种罕见的真菌感染，易被误诊。诊断标准依赖于通过骨髓涂片和组织活检明确病因。推荐脂质体两性霉素B、去氧胆酸盐两性霉素B及伊曲康唑治疗荚膜组织胞浆菌感染。
