脑型肺吸虫病误诊为结核性胸膜炎一例并文献分析  

Clinical characteristics of cerebral paragonimiasis misdiagnosed as tuberculous pleurisy and literature review

作　　者：卢晓琴 雷飞飞 李儒贵 李金科 李健 杨靖 谭华炳 Lu Xiaoqin;Lei Feifei;Li Rugui;Li Jinke;Li Jian;Yang Jing;Tan Huabing(Department of Infections Disease,Renmin Hospital,Hubei University of Medicine,Shiyan 442000,China;Department of Paediatrics,Fangxian County Renmin Hospital,Fangxian 442100,China)

机构地区：[1]十堰市人民医院(湖北医药学院附属人民医院)感染病科发热疾病研究所,十堰市442000 [2]湖北省房县人民医院儿科,房县442100

出　　处：《中华实验和临床感染病杂志（电子版）》2018年第6期621-624,共4页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

基　　金：2018年湖北省教育厅基金项目(No.B2018117);湖北医药学院校基金人体重要寄生虫创新团队(No.FDFR201603);2014年十堰市人民医院/湖北医药学院附属人民医院创新团队项目(No.201404)

摘　　要：目的探讨以胸腔积液为主要临床表现的肺吸虫病的临床特点及误诊原因。方法报告1例以胸腔积液为主要临床表现的肺吸虫病被误诊为结核性胸膜炎的患儿,予抗结核治疗3个月后因"突发抽搐2次"确诊为"脑型肺吸虫病",并进一步诊断为"混合型肺吸虫病"。结果脑肺吸虫病合并胸腔积液易被误诊为结核性胸膜炎。根据患儿临床表现及血液嗜酸性粒细胞计数(EOS),结合免疫学检测等多种方法可确诊。经吡喹酮连续治疗5个疗程获得临床治愈。结论仔细询问病史、细致体格检查、科学分析辅助检查结果是减少误诊误治、防止发生重要脏器肺吸虫病的主要措施。肺吸虫病治疗要遵守个性化原则,对肺外病灶(特别是脑肺吸虫)、病史较长的病例可能需要多疗程的驱虫治疗。Objective To investigate the clinical characteristics and misdiagnosis of paragonimiasis with pleural effusion as the main clinical manifestation.Methods A case of paragonimiasis with pleural effusion as main clinical manifestation was misdiagnosed as tuberculous pleurisy.After 3 months of anti-tuberculosis treatment,it was diagnosed as“cerebral paragonimiasis”due to“sudden convulsion twice”;and furtherly diagnosed as“mixed paragonimiasis”.Results Cerebral paragonimiasis complicated with pleural effusion was easily misdiagnosed as tuberculous pleurisy.According to the clinical manifestation,eosinophil count(EOS),and combination with immunological examination and other methods,the diagnosis was confirmed.After 5 successive courses of praziquantel treatment,clinical cure were obtained.Conclusions The main measures to reduce misdiagnosis and mistreatment and prevent the occurrence of important organ paragonimiasis are inquiring about the history of the disease carefully,examining the physical examination carefully,and analyzing the results of auxiliary examination scientifically.The treatment of paragonimiasis should follow the principle of individuation,and patients with long history of paragonimiasis,especially the cerebral paragonimiasis,may need multi-courses of treatment.

关 键 词：脑型肺吸虫病 癫痫 嗜酸性粒细胞 

分 类 号：R532.2[医药卫生—内科学]