无免疫缺陷侵袭性曲霉气管-支气管炎合并支气管肺炎1例报道

发布时间：2018-02-01 08:50

本文关键词： 侵袭性曲霉气管-支气管炎支气管镜检查诊断　出处：《上海交通大学学报(医学版)》2015年07期 　论文类型：期刊论文

【摘要】：目的探讨侵袭性曲霉气管-支气管炎(IATB)合并支气管肺炎的临床特点,提高对本病的认识。方法报道分析1例无免疫缺陷IATB合并支气管肺炎患者的临床资料,复习文献探讨其临床表现及支气管镜特点。结果患者,女,46岁,因声音嘶哑10 d,加重伴呼吸困难6 d入住耳鼻喉科。门诊纤维喉镜检查示双侧声门下见白色假膜样附着,入院后肺CT示右肺中叶不张,右肺中、下叶见不规则片状密度增高影,入院第2日因呼吸困难加重转入呼吸内科,纤维支气管镜检查距声门2~3 cm气道周围可见较多白色附着物,病理检查见大量曲霉菌菌丝,诊断IATB伴肺炎明确,予以伏立康唑抗真菌治疗,1个月后患者症状基本消失,病灶吸收。复习国内外文献报道IATB主要发生于严重免疫缺陷患者,亦可侵犯轻度免疫功能低下及健康宿主。结论提高对轻度及无免疫缺陷者侵袭性曲霉病的认识,并对不明原因剧烈咳嗽及呼吸困难患者应将IATB作为一个可能的诊断,尝试及时诊断程序,尽早行纤维支气管镜检查等明确诊断,对获得的气管-支气管假膜进行组织学检查,支气管肺泡灌洗液(BALF)进行PCR检查更有助于提高阳性率。
[Abstract]:Objective to investigate the clinical features of invasive tracheobronchial bronchitis (IATB) complicated with bronchopneumonia. Methods the clinical data of a patient with bronchopneumonia without immune deficiency IATB were analyzed and the clinical manifestations and bronchoscopy characteristics were reviewed. Results the patients were female. 46 years old, due to hoarseness for 10 days, aggravated with dyspnea for 6 days in otolaryngology. Fibrolaryngoscope examination showed white pseudomembranous attachment under bilateral acoustic hilar, and CT showed right middle lobe atelectasis on admission. In the right lung, irregular flake density shadow was seen in the lower lobe. On 2nd, severe dyspnea was transferred to the Department of Respiratory Medicine. A lot of white appendages could be seen around the airway 2cm from glottis under fiberoptic bronchoscopy. Pathological examination showed a large number of Aspergillus mycelium, the diagnosis of IATB with pneumonia is clear, the antifungal treatment with Volconazole, 1 month later the symptoms of the patients were basically disappeared. Focus absorption. Review of domestic and foreign literature reported that IATB mainly occurs in patients with severe immunodeficiency. Conclusion to improve the understanding of invasive aspergillosis in patients with mild or no immune deficiency. And for patients with severe cough and dyspnea of unknown cause, IATB should be regarded as a possible diagnosis, the diagnosis procedure should be tried in time, and fiberoptic bronchoscopy should be performed as soon as possible. Histopathological examination of the obtained tracheobronchial pseudomembrane and PCR examination of bronchoalveolar lavage fluid (BALF) were helpful to improve the positive rate.
【作者单位】：重庆市第三人民医院呼吸内科;
【分类号】：R56
【正文快照】： 人体肺部经常暴露于环境空气大量曲霉孢子中,这些孢子对免疫功能正常人群通常是无害的,但防御机制缺陷的人群吸入曲霉菌后在气道内定植、致敏、感染,可产生危及生命的侵袭性肺曲霉病(invasive pulmonary aspergillosis,IPA)[1,2]。IPA被分为不同的临床病理形式,包括急性支气管

【参考文献】