组织胞质菌病310例临床汇总分析

目的 探讨中国大陆组织胞质菌病的临床特点.方法 回顾分析310例国内正规期刊公开发表的组织胞质茵病的临床资料,包括临床表现、诊断、病原体类型、治疗及预后等.结果 310例患者中,男女之比接近2:1(214/96).36例合并有免疫功能受损(11.6%);高热262例(84.5%),肝和(或)脾肿大240例(77.4%),浅表淋巴结肿大86例(27.7%).234例(75.5%)经血涂片和(或)骨髓涂片确诊,尸检确诊6例,淋巴结活检和(或)肿物活检和(或)剖腹探查确诊36例;开胸肺活检确诊26例,经皮肺穿刺确诊6例,痰培养确诊2例.非洲型组织胞质菌3例,美洲型组织胞质菌307例(99.03%).播散型组织胞质菌感染269例,肺组织胞质菌病34例,其他类型7例.275例(88.7%)采用了抗真菌治疗;自动出院或死亡53例(17.1%),治愈257例(82.9%).华东和华南地区病例报告居多数.结论 中国大陆以美洲型组织胞质菌感染多见;发病具有性别差异,且以免疫功能健全者居多;临床表现以高热、肝脾肿大和浅表淋巴结肿大多见;误诊率高;组织病理学方法是确诊的主要手段;抗真菌治疗效果相对较好,治疗失败率17.1%;疾病分布具有地域差异.

Clinical analysis of 310 cases of histoplasmosis

Objective To explore the clinical features of histoplasmosis in China.Methods The clinical data of 310 patients of histoplasmosis were analyzed retrospectively,which were pooled from legal published periodicals.Results Ratio of male to female was about 2:1(214:96).36(11.6%)patients were immunocompromised hosts.262(84.5%)patients had hyperpyrexia.240(77.4%)patients had hepatomegaly or(and)splenomegaly.86(27.7%)patients were lymphadenectasis.Confirmed caSes made from blood smear or(and)bone marrow slides,autopsy,biopsy of lymph node or(and)exploratory laparotomy,open lung biopsy,percutaneous lung puncturation and sputum culture were 234(75.5%),6,36,26,6 and 2 respectively.307(99.03%)patients were infected by histoplasma capsulatum except 3 patients infected by histoplasma duboisii.Among the 310 patients,269 were disseminated infection,34 were pulmonary histoplasmosis,7 were other focal type.275(88.7%)patients received antifungal therapy.257(82.9%)patients were cured and 53(17.1%)patients had no response to therapy because of their severe condition.The eastern and southern areas of China were the main endemic region of histoplasmosis.Conclusion In China,histoplasma eapsulatum infection occurs more often than histoplasma duboisii.The disease has gender difference.Most of the patients are in their normal immune conditions.Hyperpyrexia,hepatomegaly,splenomegaly and lymphadenectasis are the dominant clinical manifestations.The misdiagnosis rate is high.Histopathology is the main method of diagnosis.Most patients have good response to antifungal therapy.The rate of traatment failure is 17.1%.The histoplasmosis occurs more often along the coast of southern and eastern in Chinese mainland.