Department of Geriatrics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
Department of Respiratory and Critical Care Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
J Infect Dev Ctries. 2024 Feb 29;18(2):318-325. doi: 10.3855/jidc.17934.
Pulmonary histoplasmosis is a fungal disease that is endemic in North and Central America. It is relatively rare in China and commonly misdiagnosed as tuberculosis or cancer due to nonspecific clinical and radiographic manifestations. Rapid and accurate pathogen tests are critical for the diagnosis of pulmonary histoplasmosis.
We report two cases of pulmonary histoplasmosis. We collected all the relevant case reports on the Chinese mainland (from 1990 to 2022) to analyze features of this disease among Chinese patients.
A total of 42 articles reporting 101 cases were identified, and the two cases reported in this article were also included for analysis. Sixty-three (61.2%) patients had respiratory symptoms and 35 (34.0%) patients were asymptomatic. The most common radiographic findings were pulmonary nodules or masses (81.6%). Twenty-two (21.4%) patients were misdiagnosed as tuberculosis, and 37 (35.9%) were misdiagnosed as lung tumors before pathological findings. Metagenomic next‑generation sequencing (mNGS) testing provided a rapid diagnostic and therapeutic basis for three patients.
Clinical features and imaging findings of pulmonary histoplasmosis are not specific. Relevant epidemiological history and timely pathogen detection are important for diagnosis. mNGS can shorten the time required for diagnosis and allow earlier initiation of targeted antibiotic therapy.
肺组织胞浆菌病是一种真菌病，流行于北美和中美洲。在中国相对较少见，由于临床表现和影像学表现不具特异性，常被误诊为结核病或癌症。快速准确的病原体检测对肺组织胞浆菌病的诊断至关重要。
我们报告了两例肺组织胞浆菌病病例。我们收集了中国大陆（1990 年至 2022 年）所有相关的病例报告，以分析中国患者的疾病特征。
共确定了 42 篇报告 101 例病例的文章，本文还报告了这两例病例进行分析。63 例（61.2%）患者有呼吸道症状，35 例（34.0%）患者无症状。最常见的影像学表现为肺部结节或肿块（81.6%）。22 例（21.4%）患者被误诊为结核病，37 例（35.9%）在病理发现之前被误诊为肺部肿瘤。宏基因组下一代测序（mNGS）检测为 3 例患者提供了快速诊断和治疗依据。
肺组织胞浆菌病的临床特征和影像学表现不具特异性。相关的流行病学史和及时的病原体检测对诊断很重要。mNGS 可以缩短诊断所需的时间，并允许更早地开始靶向抗生素治疗。
