支气管肺蠊缨滴虫感染二例并文献复习

目的 提高对支气管肺蠊缨滴虫病的认识与诊断水平.方法 分析武警部队上海总队医院呼吸内科确诊的2例支气管肺蠊缨滴虫病的临床资料,结合1993-2006年文献报道的13例共15例进行文献复习.结果 (1)2例患者中,1例表现为重症哮喘,反复夜间发作咳嗽、胸闷、气喘,肺部听诊可闻及哮鸣音,支气管镜检查提示右上叶支气管狭窄、黏膜充血水肿;1例表现为支气管扩张伴感染迁延不愈,患者反复咳嗽、咳痰伴低热,胸部X线片、CT示双肺多个叶段支气管扩张伴感染,支气管镜检查提示支气管黏膜充血水肿,管腔狭窄,支气管管腔内可见白色坏死样物.2例均经支气管镜检查采集标本检验后明确诊断.(2)文献报道的13例均经病原学检查并由寄生虫病专家鉴定,诊断依据确凿.支气管肺蠊缨滴虫病最常见的症状是发热(64.3%)和咳嗽、咳痰(71.4%),半数患者外周血嗜酸性粒细胞数增多,X线胸片及胸部CT影像以肺炎样改变多见(占摄片数83.3%),慢性患者可表现为支气管哮喘、支气管扩张、肺脓肿等.痰液和经支气管镜检查采集标本,直接涂片检查是明确病原的方法.结论 支气管肺蠊缨滴虫病为新发感染性疾病,感染人体的蠊缨滴虫的宿主、传播途径、易感人群等尚不清楚,治疗亦需进一步研究.

Bronchopulmonary Lophomonas blattarum infection: two cases report and literature review

Objective To improve the recognition and diagnosis of pulmonary Lophomonas blattarum infection. Methods Two cases of bronchopulmonary Lophomonas blattanan diagnosed in this hospital were reported. The clinical features of 13 cases in the literature during the period of 1993 to 2006,1 case with sinus infection and 12 cases with bronchopulmonary infection, were also analyzed. Results For the 2 cases diagnosed in this hospital, severe asthma and bronchiectasis withprolonged infection were the underlying diseases, respectively. The diagnosis of these 2 cases and the 13 cases reported in the literature were all confirmed by the presence of parasites in airway samples. The most common symptoms included fever (64.3% ), cough and expectoration (71.4%). Fifty percent of the patients showed increased eosinophils in peripheral blood. Chest radiograph and CT scan showed changes similar to pneumonia(83.3%). Chronic cases were manifested with asthma attack, branchiectasis or lung abscess. Smear preparations of sputum or specimen by bronchoscopy were direct methods for diagnosis. Conclusion Pulmonary Lophonomas blattarum infection is an emerging infectious disease caused by protozoon of hypermastigote parasitized in the bronchus or the lung. Epidemiological characteristics including host, route of transmission and susceptible population of Lophomonas blattarum infection are not fully understood. The optimal treatment also needs further investigation.