HIV感染合并组织胞浆菌病7例临床观察及误诊分析  

Seven cases of HIV infection combined with histoplasmosis:clinical observations and analysis of misdiagnosis

作　　者：张炜[1] 徐小平[1] 瞿章书[1] 洪桥爱[1] 汤丽娟[1] 姚茂军[1] 黄健生[1] 徐兰芳[1] 

机构地区：[1]吉首大学附属第一人民医院,湖南吉首416000

出　　处：《中华实验和临床感染病杂志（电子版）》2009年第3期16-19,共4页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

摘　　要：目的对我院2006～2007年收治的7例HIV合并组织胞浆菌病病例进行回顾性研究,对比临床表现并进行误诊原因分析。方法从一般资料、临床症状、辅助检查、误诊疾病、确诊方法及确诊经过,分别列项比较。结果(1)临床表现多样,7例患者均有误诊经过:误诊为肺结核3例,伤寒1例,血液病2例,淋巴瘤1例。误诊时间:最短1个月,最长12个月,平均5个月;(2)治疗:抗口腔真菌感染相对有效。均因误诊未能及时确诊,而未使用HIV抗病毒用药;(3)7例患者,最终5例死亡,2例出院门诊未能随访。结论(1)HIV感染合并组织胞浆菌病极易误诊,病死率高。组织胞浆菌感染后,在免疫功能低下时可发展成播散型组织胞浆菌病(disseminated histoplasmosis),累及单核巨噬细胞系统,如骨髓、肝、脾、淋巴结等。在病情进展过程中,其临床表现和相关实验室检查呈多样性,X片及CT近似结核、淋巴结肿大,要与与淋巴结结核及淋巴瘤鉴别,血细胞减少并感染症多误诊为血液病等,且治疗效果极差;(2)误诊的原因分析:①满足于对常见病、多发病的诊断;②病情早期临床表现多样,缺乏特异性,易以偏概全;③忽视接诊时详细询问病史及完善体格检查。Objective Seven cases diagnosed as HIV infection combined with histoplasmosis in our hospital from 2006 to 2007 were studied retrospectively, the clinical manifestations were compared and the reasons for misdiagnosis were analysed. Methods Six indexes were compared respectively： general information, clinical symptoms, supplementary examination, misdiagnosed diseases, diagnosis methods and the process of diagnosis. Results （ 1 ） Clinical manifestations of 7 cases diversified and all had been misdiagnosed： 3 cases misdiagnosed as tuberculosis, 1 case as typhoid, 2 cases as blood disorders and lymphoma in 1 case. Misdiagnosis lasted： the shortest for 1 month and the longest for 12 months, with an average of 5 months. （2） Treatment： oral anti-fungal drugs is relatively effective, while anti-HIV virus medication was not carried out due to misdiagnosis. （3） Five of 7 cases died finally and 2 cases discharged from hospital but failed to follow up. Conclusions （1） Patients with HIV infection and histoplasmosis are vulnerable to be misdiagnosed and the fatality rate is very high. Capsulatum infection in immunocompromised may develop into disseminated histoplasmosis, involving the monocyte-macrophage system such as bone marrow, liver, spleen, lymph nodes and so on. During the progress, its clinical manifestations and laboratory tests showed the diversity, X-ray and CT inspection are similar to tuberculosis or swollen lymph nodes, so it need to be identified from tuberculosis or lymphoma. The infection symptoms with blood cells reduced were often misdiagnosed as blood diseases, also with poor treatment. （2） Analysis of misdiagnosis reasons： （1） doctors are satisfied with common and frequently-occurring diseases diagnosis. （2） clinical manifestations of the diseases at early time are diverse which lack the specificity and easy to draw conclusions from a part. （3） reception doctors neglect detailed inquiry of medical history and perfect medical examination.

关 键 词：HIV感染 组织胞浆菌病 误诊分析 

分 类 号：R512.91[医药卫生—内科学] R519[医药卫生—临床医学]