CAJ | 학술논문

目的探讨输入型肺组织胞浆菌病的临床、影像及病理特征及治疗方法,提高临床医生对该病的鉴别诊断能力.方法对3例输入型肺组织胞浆菌病病例的临床、影像及病理学表现和治疗进行分析,并分别以“imported pulmonary histoplasmosis"、“输入病例”和“肺组织胞浆菌”为关键词在PubMed数据库和中国期刊全文数据库、万方数据库和维普数据库中检索1989-2014年发表的相关文献,对其中所有输入型肺组织胞浆菌病病例进行分析,阐述输入型肺组织胞浆菌病的临床特征、诊断和治疗措施.结果 3例肺组织胞浆菌病患者均为免疫正常宿主,均为男性,年龄44～67岁,有流行区蝙蝠洞/坑道暴露史,发病后症状轻重不一,但均出现流感样症状,影像学表现为双肺多发随机分布的结节影,伴纵隔淋巴结肿大.3例分别行经皮肺穿刺或开胸肺活检,病理组织学均表现为肉芽肿性炎症伴坏死,1例穿刺肺组织培养肺组织胞浆菌阳性.3例经伊曲康唑治疗后肺部病变吸收良好.共检索到13篇关于输入型肺组织胞浆菌病的外文文献,共报道60例患者,男42例,女16例,未报道性别2例,年龄为17 ～64岁.未检索到中文文献.这些患者的共同特征与本文病例一致,即流行病学史、流感样症状、双肺多发结节样病变,经抗真菌治疗或自行好转.结论输入型肺组织胞浆菌病例的流行病史、流感样症状、双肺多发结节样病变等临床表现有重要的诊断价值,如果排除其他原因,即使无明确病原,根据临床表现、组织病理和对抗真菌治疗的良好反应也可诊断.
목적 탐토수입형폐조직포장균병적림상、영상급병리특정급치료방법,제고림상의생대해병적감별진단능력.방법 대3례수입형폐조직포장균병병례적림상、영상급병이학표현화치료진행분석,병분별이“imported pulmonary histoplasmosis"、“수입병례”화“폐조직포장균”위관건사재PubMed수거고화중국기간전문수거고、만방수거고화유보수거고중검색1989-2014년발표적상관문헌,대기중소유수입형폐조직포장균병병례진행분석,천술수입형폐조직포장균병적림상특정、진단화치료조시.결과 3례폐조직포장균병환자균위면역정상숙주,균위남성,년령44～67세,유류행구편복동/갱도폭로사,발병후증상경중불일,단균출현류감양증상,영상학표현위쌍폐다발수궤분포적결절영,반종격림파결종대.3례분별행경피폐천자혹개흉폐활검,병리조직학균표현위육아종성염증반배사,1례천자폐조직배양폐조직포장균양성.3례경이곡강서치료후폐부병변흡수량호.공검색도13편관우수입형폐조직포장균병적외문문헌,공보도60례환자,남42례,녀16례,미보도성별2례,년령위17 ～64세.미검색도중문문헌.저사환자적공동특정여본문병례일치,즉류행병학사、류감양증상、쌍폐다발결절양병변,경항진균치료혹자행호전.결론 수입형폐조직포장균병례적류행병사、류감양증상、쌍폐다발결절양병변등림상표현유중요적진단개치,여과배제기타원인,즉사무명학병원,근거림상표현、조직병리화대항진균치료적량호반응야가진단.
Objective To describe the clinical features and treatment of imported pulmonary histoplasmosis and therefore to improve the recognition and differential diagnosis of this disease.Methods The clinical data of 3 patients with imported pulmonary histoplasmosis in our hospital were collected and analyzed.Literatures published since 1989 were retrieved with ‘pulmonary histoplasmosis’ from PubMed,China National Knowledge Infrastructure(CNKI),Wanfang Data and VIP data,of which all the literatures about imported pulmonary histoplasmosis were reviewed.The clinical manifestations,diagnostic methods and treatment were summarized.Results All the 3 cases of imported pulmonary histoplasmosis were immunocompetent hosts,all were males,age were from 44-67 years,and had a history of exploring the cave or tunnel inhabited by bats in the epidemic areas.All of them developed influenza-like symptoms varying in severity after the onset of the disease.Pulmonary multiple nodules and mediastinal lymphadenopathy were found on chest images.One patient underwent percutaneous lung biopsy and the other two received video-assisted thoracoscopic lung biopsy.All the 3 patients showed consistent histopathological findings,such as granulomatous inflammation with necrosis.Pathogen culture with lung biopsy in the first case was identified as histoplasma.All the 3 cases were treated with itraconazole,and recovered with good prognosis.Thirteen literatures in English were obtained,which reported 60 cases with imported pulmonary histoplasmosis.Forty-two of them were males,16 were females and 2 undefined.The range of their age was from 17-64 years.No imported pulmonary histoplasmosis was reported so far in Chinese literature.Common features of imported pulmonary histoplasmosis were consistent with our patients,including epidemiology,influenza-like symptoms and bilateral pulmonary nodules,recovery with or without antifungal therapy.Conclusion The epidemiologic history,influenza-like symptoms and bilateral pulmonary nodules provide valuable diagnostic clues for imported histoplasmosis.Clinical features with pathologic findings and good response to antifungal therapy could make the diagnosis even without pathogen detection if other etiology is unlikely.