无免疫功能缺陷的肺隐球菌病19例误诊分析

发布时间：2018-06-12 05:40

本文选题：肺疾病 + 隐球菌病　；参考：《临床误诊误治》2016年01期

【摘要】：目的探讨无免疫功能缺陷的肺隐球菌病临床特点及误诊原因。方法回顾性分析我院2010年6月—2014年10月收治的19例无免疫功能缺陷的肺隐球菌病误诊病例资料。结果本组以中青年男性为主,以咳嗽、发热、咳痰为主要表现,14例(73.7%)影像学表现为结节型肿块。入院初期误诊为肺结核6例(31.6%),肺癌5例(26.3%),普通细菌感染4例(21.1%),误诊率达78.9%。均经病理检查确诊肺隐球菌病,其中经皮肺穿刺活组织病理检查确诊13例,术后病理检查确诊5例,气管镜肺活组织病理检查确诊1例。6例(31.6%)经外科手术切除,13例(68.4%)予氟康唑抗真菌治疗,效果满意,随访0.5~1年未发现病情复发或其他脏器播散。结论肺隐球菌病在免疫功能正常人群中亦可发病;肺隐球菌病影像学表现形式多种多样,需与肺结核、肺癌及机化性肺炎相鉴别,病原学检查和肿块活组织病理检查对于鉴别诊断至关重要,尤其PAS染色诊断敏感性极高。
[Abstract]:Objective to investigate the clinical features and misdiagnosis of pulmonary cryptococcosis without immune deficiency. Methods A retrospective analysis of 19 misdiagnosed cases of pulmonary cryptococcosis without immune deficiency was made from June 2010 to October 2014 in our hospital. Results the main manifestations of this group were young and middle-aged men, with cough, fever and expectoration as the main manifestations. At the initial stage of admission, 6 cases were misdiagnosed as pulmonary tuberculosis, 5 cases as lung cancer, and 4 cases as common bacterial infection. The misdiagnosis rate was 78.9%. Pulmonary cryptococcosis was confirmed by pathological examination. 13 cases were confirmed by percutaneous biopsy of lung biopsy, 5 cases were confirmed by pathological examination after operation. Tracheoscopic lung biopsy confirmed 6 cases (31. 6%) were treated with fluconazole antifungal therapy by surgical resection (13 cases). No recurrence or other organ spread was found during the follow up period of 0. 5 ~ 1 year. Conclusion Lung Cryptococcosis may also occur in normal immune population, and the imaging manifestations of pulmonary cryptococcosis need to be distinguished from pulmonary tuberculosis, lung cancer and organic pneumonia. Etiology and biopsy of masses are very important for differential diagnosis, especially pas staining is highly sensitive.
【作者单位】：复旦大学附属上海市第五人民医院呼吸内科;皖南医学院临床医学系;
【分类号】：R519.4

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