Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
Department of Hematology Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
BMC Prim Care. 2022 Aug 8;23(1):197. doi: 10.1186/s12875-022-01771-2.
Acute histoplasmosis is a rare fungal disease in China. This study is aimed to summarize the clinical characteristics of the first large-scale outbreak of imported acute histoplasmosis in Chinese, so as to provide suggestions for clinical diagnosis and treatment.
We collected the symptoms, signs, laboratory examination and imaging data of 10 patients in so far the biggest outbreak of imported acute histoplasmosis in immunocompetent Chinese. Their clinical characteristics and time-varying cytokine/chemokine levels were analyzed, and rank correlation analysis between these markers was utilized to show their condition.
The 10 patients of imported acute histoplasmosis were working without any respiratory protection in an abandoned mine tunnel in Guyana. The most common symptoms were fever and cough. Their chest CT imaging showed multiple nodular shadows in lungs. Laboratory examination showed that at admission the CRP, PCT, LDH, CysC, G-test, β2-MG were all increased in at least 9 patients, and the CD4/CD8 was decreased to < 1 in all patients. Most cytokines/chemokines (other than IL-4, IL-12, INF-α, TNF-α) varied widely with patients and time, but their overall trend is higher at admission and decreasing gradually during hospitalization, especially for the IL-6, IL-8, IL-10 and IFN-γ. The LDH, CysC, G-test, β2-MG, N/L, IL-6, IL-8, IL-10, IFN-γ, IL-27 are in positive associations to both CRP and PCT.
The diagnosis of acute histoplasmosis needs a comprehensive analysis of epidemiological history, clinical symptoms and signs, and results of imaging, laboratory, microbiological and pathological examinations. Although none of the CRP, PCT, G-test, N/L, LDH, CysC, β2-MG, IL-6, IL-8, IL-10, IFN-γ shows specificity in the diagnosis of acute histoplasmosis, there is possibility that the above factors might help in the inflammation and prognosis estimation. However, more studies and further investigation are still required for the verification.
急性组织胞浆菌病在中国是一种罕见的真菌病。本研究旨在总结首例中国免疫功能正常人群中发生的大规模输入性急性组织胞浆菌病暴发的临床特征，为临床诊断和治疗提供建议。
我们收集了迄今为止中国最大规模免疫功能正常人群输入性急性组织胞浆菌病暴发中 10 例患者的症状、体征、实验室检查和影像学数据。分析了他们的临床特征和时变细胞因子/趋化因子水平，并利用秩相关分析显示了这些标志物之间的关系。
10 例输入性急性组织胞浆菌病患者在圭亚那一个废弃的矿道中工作时未采取任何呼吸防护措施。最常见的症状是发热和咳嗽。他们的胸部 CT 影像学显示肺部有多发性结节影。实验室检查显示，入院时至少有 9 例患者的 CRP、PCT、LDH、CysC、G 试验、β2-MG 均升高，所有患者的 CD4/CD8 均<1。大多数细胞因子/趋化因子（除 IL-4、IL-12、INF-α、TNF-α 外）在患者和时间上差异较大，但总体趋势是入院时较高，住院期间逐渐降低，尤其是 IL-6、IL-8、IL-10 和 IFN-γ。LDH、CysC、G 试验、β2-MG、N/L、IL-6、IL-8、IL-10、IFN-γ、IL-27 与 CRP 和 PCT 均呈正相关。
急性组织胞浆菌病的诊断需要综合分析流行病学史、临床症状和体征以及影像学、实验室、微生物学和病理学检查结果。虽然 CRP、PCT、G 试验、N/L、LDH、CysC、β2-MG、IL-6、IL-8、IL-10、IFN-γ 在诊断急性组织胞浆菌病方面均无特异性，但上述因素可能有助于炎症和预后评估。然而，还需要更多的研究和进一步的调查来验证。
