地方性流行地区的小儿组织胞浆菌病：当代分析。

Pediatric Histoplasmosis in an Area of Endemicity: A Contemporary Analysis.

机构信息

Division of Infectious Diseases and Host Defense Program.

Biostatistics, Division of Hematology and Oncology.

出版信息

J Pediatric Infect Dis Soc. 2019 Nov 6;8(5):400-407. doi: 10.1093/jpids/piy073.

DOI:10.1093/jpids/piy073

PMID:30124985

Abstract

BACKGROUND

Data on pediatric histoplasmosis have been limited to those from outbreak and case reports. We sought to evaluate the contemporary clinical manifestations, laboratory findings, and outcomes in children with histoplasmosis living in an area of endemicity.

METHODS

This study was a single-center retrospective review of proven and probable cases of histoplasmosis in children aged 0 to 18 years between April 2008 and April 2014. Case ascertainment was ensured by us using International Classification of Diseases, Ninth Revision codes cross-referenced with laboratory, microbiology, and histopathology tests that detected Histoplasma capsulatum. Demographics, diagnostics, clinical management, and outcomes were evaluated.

RESULTS

Seventy-three children with histoplasmosis (41 males; median age, 13 years [range, 3-18 years]) were diagnosed with proven (n = 17 [23%]) or probable (n = 56 [77%]) histoplasmosis, which manifested as pulmonary (n = 52 [71%]) or disseminated (n = 21 [29%]) disease. Symptoms at presentation were nonspecific; the examination of 21 (29%) patients revealed abnormal physical findings. Detection of H capsulatum by serologic methods occurred in 93% (63 of 68) of the patients tested. Histoplasma antigen in blood or urine was detected in 42% (20 of 48) and 28% (15 of 53) of the patients tested, respectively. The 16 (22%) patients who were immunocompromised had significantly higher rates of disseminated disease (56% vs 21%, respectively; P = .01), antigenuria (62% vs 18%, respectively; P = .004), and antigenemia (69% vs 31%, respectively; P = .02) and longer durations of antigenuria (403 vs 120 days, respectively; P = .003) and antigenemia (451 vs 149 days, respectively; P < .0001) than did the immunocompetent children.

CONCLUSIONS

Pediatric histoplasmosis manifests most frequently as pulmonary disease. The highest diagnostic yield was achieved when multiple diagnostic modalities were used. Presentation with disseminated disease and evidence of antigenemia, antigenuria, and delayed antigen clearance were more likely to be seen in immunocompromised children.

摘要

背景

儿科组织胞浆菌病的数据仅限于暴发和病例报告。我们试图评估生活在流行地区的儿童中组织胞浆菌病的当代临床表现、实验室发现和结局。

方法

这是一项单中心回顾性研究，纳入了 2008 年 4 月至 2014 年 4 月期间年龄在 0 至 18 岁之间的确诊和可能的组织胞浆菌病患儿。通过国际疾病分类，第九版代码与检测荚膜组织胞浆菌的实验室、微生物学和组织病理学检查进行交叉参考，确保了病例的确定。评估了人口统计学、诊断、临床管理和结局。

结果

73 例组织胞浆菌病患儿（41 例男性；中位年龄 13 岁[范围，3-18 岁]）被诊断为确诊（n = 17[23%]）或可能（n = 56[77%]）组织胞浆菌病，表现为肺部（n = 52[71%]）或播散性（n = 21[29%]）疾病。发病时的症状无特异性；21 例（29%）患儿的体格检查异常。93%（63/68）检测的患儿血清学方法检测到荚膜组织胞浆菌。42%（20/48）和 28%（15/53）检测的患儿分别在血液或尿液中检测到组织胞浆菌抗原。16 例（22%）免疫功能低下的患儿播散性疾病的发生率显著更高（分别为 56%和 21%；P =.01），尿抗原（分别为 62%和 18%；P =.004）和血抗原（分别为 69%和 31%；P =.02），尿抗原和血抗原的持续时间也更长（分别为 403 天和 120 天；P =.003）和 451 天和 149 天；P <.0001）比免疫功能正常的患儿。