儿童肺隐球菌病八例及临床分析  

Eight cases report of pulmonary cryptococcosis in children and clinical analysis

作　　者：侯伟[1] 王亚坤[1] 贾美轩 钱小娜 田利远[1] Hou Wei;Wang Yakun;Jia Meixuan;Qian Xiaona;Tan Liyuan(The First Department of Respiratory Medicine,Hebei Children′s Hospital,Hebei Medical University,Shijiazhuang 050031,China)

机构地区：[1]河北医科大学附属河北省儿童医院呼吸一科,石家庄050031

出　　处：《国际呼吸杂志》2020年第22期1746-1750,共5页International Journal of Respiration

基　　金：河北省科技计划项目(15277705D)。

摘　　要：目的总结儿童肺隐球菌病临床资料,以提高认识。方法回顾性分析河北省儿童医院2012年3月至2019年9月收治的8例肺隐球菌病患儿的一般资料、临床表现、实验室检查、影像学表现、病原学检查、治疗与转归。结果8例患儿免疫功能检查均正常,其中4例有禽类接触史。8例患儿均有长期发热,7例伴有轻微咳嗽。8例患儿外周血白细胞升高;6例嗜酸粒细胞升高;6例IgE升高。6例患儿肺部CT表现为多发斑片、结节、条索样高密度影,2例表现为双肺弥漫粟粒样小结节影,7例伴有纵隔和/或肺门淋巴结肿大,8例伴有腹腔淋巴结肿大。6例患儿新生隐球菌培养阳性确诊,其中3例第一次培养阴性,第二次培养阳性确诊;2例患儿隐球菌荚膜抗原阳性确诊。8例患儿均给予抗真菌治疗,其中1例发生肺外播散患儿临床控制不佳,其余预后良好。结论免疫功能正常儿童可患肺隐球菌病,长期发热是最主要临床表现。外周血白细胞升高、嗜酸粒细胞升高、IgE升高是急性期相对特异实验室检查。影像学表现以双肺结节为主,常伴多组淋巴结肿大,多次多部位真菌培养可提高确诊率。Objective To summarize the clinical data of children with pulmonary cryptococcosis so as to enhance understanding.Methods Retrospective analysis of the general information,clinical manifestations,laboratory examinations,imaging findings,etiological examinations,treatment and outcomes of eight children with cryptococcosis treated by Hebei Children′s Hospital from March 2012 to September 2019.Results All 8 children′s immune function was tested normal,and four of them once contacted with poultry.All 8 children patients suffered from prolonged fever and seven of them coughed slightly.All 8 children patients were tested with increased white blood cell counts.There were 6 children patients tested with high eosinophilia.Six children were tested high IgE.Six children′s CT lung showed that multiple plaques,nodules and strip-like high density shadows exist.Two children′s two lungs were covered with miliary-like nodule shadow.Seven children′s mediastinum and(or)hilar lymph nodes were enlarged.Eight children′s abdominal lymphadenopathy was enlarged.Six children′s culture of cryptococcus neoformans were tested positive,and three of them were tested negative in fungal culture at the first time but positive at the second time.Two children were tested positive in cryptococcus capsular antigen.Eight children were all treated with antifungal therapy,one of which wasn′t cured well after extrapulmonary diffusion.However,others get back in shape.Conclusions Children with normal immune function can be infected by pulmonary cryptococcosis,who has a fever.The relatively specific laboratory examination shows with increased white blood cell counts,high eosinophilia and high IgE.What′s more,CT lung shows with bilateral pulmonary nodules,which is often accompanied by multiple groups of lymph node enlargement.Fungal culture in many body parts in many times is proved useful in improving the diagnostic rate.

关 键 词：隐球菌病 儿童 免疫功能正常 

分 类 号：R725.6[医药卫生—儿科]