14例热带地区非免疫抑制宿主肺隐球菌病临床分析  

Clinical analysis of 14cases of pulmonary cryptococcosis in non-immunosuppressed hosts in tropical areas

作　　者：师凌昊 李玉柱[1] 赵晓鹏 林锦绣 李晟姝 赵微[2] SHI Ling-hao;LI Yu-zhu;ZHAO Xiao-peng;LIN Jin-xiu;LI Sheng-shu;ZHAO Wei(Hainan Hospital of PLA General Hospital,Sanya,Hainan 572013,China;不详)

机构地区：[1]解放军总医院海南医院呼吸与危重症医学科,海南三亚572013 [2]解放军总医院第一医学中心呼吸与危重症医学科,北京100853

出　　处：《中华医院感染学杂志》2020年第20期3108-3112,共5页Chinese Journal of Nosocomiology

摘　　要：目的总结热带地区肺隐球菌病的宿主因素、临床特点、影像学特征及治疗预后,提高对肺隐球菌病诊治的认识。方法回顾性分析2014年5月-2019年7月解放军总医院海南医院符合确诊标准的肺隐球菌病病例。结果入选病例14例,男性9例,女性5例,平均年龄50.79(29~77)岁。起病症状多样,包括胸痛(5/14,35.71%),胸闷(3/14,21.43%),咳嗽、咳痰(2/14,14.29%),咯血(2/14,14.29%)等,4例(28.57%)无明显症状。所有病例均经病理确诊,初诊误诊率100%,易误诊为肺癌、细菌感染、结核,平均确诊时间32.36(5~233)天。肺CT影像学特点:病灶分布于左肺7例(50.00%),右肺4例(28.57%),双肺3例(21.43%);病灶可表现为大结节型(7/14,50.00%),小结节型(5/14,35.71%),实变/混合型(1/14,7.14%),空洞型(1/14,7.14%);可有分叶/毛刺、晕征、胸膜增厚/牵拉、纵隔淋巴结肿大等伴随表现。本研究中5例(35.71%)经外科手术切除病灶治愈,9例(64.29%)接受药物治疗,其中8例(57.14%)接受氟康唑单药治疗,7例(87.50%)治愈,1例(12.50%)好转;1例接受两性霉素B强化氟康唑序贯治疗后治愈。结论肺隐球菌病可发病于热带地区非免疫抑制宿主,且多无鸽子接触史,起病症状多样,肺CT表现缺乏特异性,误诊率高,确诊主要依赖病理检查。手术治疗可治愈,药物治疗疗效确切,不良反应少,总体预后良好。OBJECTIVE To summarize the host factors,clinical characteristics,imaging characteristics and treatment prognosis of pulmonary cryptococcosis in tropical areas.METHODS The cases of pulmonary cryptococcosis that met the diagnostic criteria in Hainan Hospital of PLA General Hospital from May 2014to July 2019were retrospectively analyzed to improve the diagnosis and treatment of the disease.RESULTS There were 14selected cases,9males and 5females,with an average age of 50.79(29-77)years old.The onset symptoms of patients were diverse,including chest pain(5/14,35.71%),chest tightness(3/14,21.43%),cough,sputum(2/14,14.29%),hemoptysis(2/14,14.29%),etc.,and 4cases(28.57%)had no obvious symptoms.All cases were diagnosed pathologically,and the initial misdiagnosis rate was 100%.It was easy to be misdiagnosed as lung cancer,bacterial infection,and tuberculosis.The average diagnosis time was 32.36(5-233)days.The features of lung CT imaging included 7cases(50.00%)with lesions located in the left lung,4cases(28.57%)in the right lung,and 3cases(21.43%)in both lungs;the lesions could be presented as large nodules type(7/14,50.00%),small nodular type(5/14,35.71%),consolidation/mixed type(1/14,7.14%),hollow type(1/14,7.14%);and might be accompanied by split leaves/burrs,halo signs,Pleural thickening/traction,mediastinal lymphadenopathy and so on.In this study,5cases(35.71%)were cured by surgical resection of the lesion,9cases(64.29%)received drug treatment,of which 8cases(57.14%)received fluconazole monotherapy,7cases(87.50%)were cured,1case(12.50%)improved;1case was cured after receiving amphotericin B intensified fluconazole sequential therapy.CONCLUSIONPulmonary cryptococcosis could occur in non-immunosuppressive hosts in tropical areas,and most of them have no history of exposure to pigeons.The onset symptoms were diverse,lung CT imaging lacked specificity,and the misdiagnosis rate was high,and the diagnosis mainly depended on pathological examination.Surgical treatment was curable,drug treatment had definite curative effect,wi

关 键 词：肺隐球菌病 免疫状态 临床表现 诊断 治疗 

分 类 号：R378[医药卫生—病原生物学]