新型冠状病毒肺炎恢复期核酸复阳合并肺隐球菌感染1例分析  

A case report of nucleic acid positive again combined with cryptococcal infection in COVID-19 recovery period

作　　者：钟少华[1] 林锋[1] 符娟[1] 高慧[1] 吴彪[1] ZHONG Shao-hua;LIN Feng;FU Juan;GAO Hui;WU Biao(Department of Infectious Diseases,Hainan General Hospital(Hainan Affiliated Hospital of Hainan Medical University),Haikou,Hainan 570011,China)

机构地区：[1]海南省人民医院,海南医学院附属海南医院感染科,海南海口570011

出　　处：《中国热带医学》2021年第9期903-906,共4页China Tropical Medicine

基　　金：海南省社会发展基金(No.ZDYFXGFY2020004);白求恩·医学科学研究基金(No.SG070DS)。

摘　　要：目的分析1例新型冠状病毒肺炎恢复期核酸复阳合并肺隐球菌患者被误诊为肺恶性肿瘤,经手术病理证实肺隐球菌的治疗过程及转归,为该类患者的诊治提供依据。方法选择海南省人民医院感染科收治的1例新型冠状病毒肺炎恢复期核酸复阳合并肺隐球菌感染患者,分析其一般情况、临床表现、实验室检查、诊断、治疗及预后等临床资料。结果患者在恢复期时肺部影像学病灶较前吸收,随访出现核酸复阳时无明显临床症状,合并肺部新发结节病灶,误诊为肺恶性肿瘤,行肺癌根治术,病理证实为肺隐球菌感染,经给予氟康唑抗真菌治疗后痊愈,院外随访未遗留后遗症。结论复阳患者可无临床症状,在新冠肺炎疫情期间对合并肺结节患者应理性对待,肺隐球菌患者临床表现隐匿,容易出现误诊,对疑诊侵袭性肺隐球菌感染患者应及时行支气管镜检查、真菌培养、真菌血清学及组织活检,有助于及早诊断、精准治疗、提高临床治疗疗效。Objective To analyze the patients with pulmonary cryptococcosis who were misdiagnosed as lung malignant tumors during the recovery period of COVID-19.The treatment process and outcome of pulmonary cryptococcus were confirmed by surgery and pathology,which provided basis for the diagnosis and treatment of such patients.Methods A patient with nucleic acid positive again and cryptococcal infection in the convalescent stage of COVID-19 admitted to the Department of Infectious Diseases of Hainan Provincial People's Hospital was selected to analyze its general conditions,clinical manifestations,laboratory examinations,diagnosis,treatment and prognosis and other clinical data.Results During the recovery period,the patient’s lung imaging showed the lesion was absorbed,and there was no obvious clinical symptoms when nucleic acid positive again appeared in follow-up,combined with new pulmonary nodules,misdiagnosed as lung malignant tumor,radical resection of lung cancer was performed,and pathologically confirmed as lung cryptococcosis infection,the patient healed after fluconazole antifungal treatment,and no sequelae were left in the out-of-hospital follow-up.Conclusion Patients with nucleic acid positive again may have no clinical symptoms,and patients with pulmonary nodules should be treated rationally during the COVID-19 epidemic.Patients with pulmonary cryptococcus have hidden clinical manifestations and are prone to misdiagnosis.For patients with suspected invasive pulmonary cryptococcal infection,bronchoscopy,fungal culture,fungal serology and tissue biopsy should be performed in time,which is helpful for early diagnosis,precise treatment,and clinical improvement therapeutic effect.

关 键 词：新型冠状病毒 新型冠状病毒肺炎 隐球菌感染 

分 类 号：R563.1[医药卫生—呼吸系统]