两例荚膜组织胞浆菌肺部感染患者诊治研究

发布时间：2018-05-13 12:29

本文选题：组织胞浆菌 + 组织胞浆菌病　；参考：《中华医院感染学杂志》2014年10期

【摘要】：目的探讨组织胞浆菌病实验室和临床诊治特点,为减少组织胞浆菌病的漏检率和病死率提供经验。方法调查两例由荚膜组织胞浆菌引起的肺组织胞浆菌病临床资料,分析其组织胞浆菌病患者流行病学史和治疗原则及疗效;采用萨布罗和血琼脂培养基进行病原菌培养。结果两例患者均为有组织胞浆菌暴露史的人群,两例患者伊曲康唑治疗约4个月后均有明显效果;该菌初代在萨布罗培养基真菌孵箱培养10d后,生长出微小、白色干燥菌落,血琼脂于普通孵箱20d后长出酵母样菌落;组织标本剪碎后涂片,六胺银染色查见真菌大分生孢子,有管型和柱型的突起;次代生长的菌落通过乳酸棉酚兰、革兰染色均见到典型的大分生孢子,50%的大分生孢子表面有管型和柱型突起。结论组织胞浆菌培养困难和时间长,组织剪碎后涂片行六胺银染色镜下见真菌大分生孢子,有管型和柱型的突起,可以提前提示实验室内要考虑组织胞浆菌的培养和鉴定,医学实验室和临床均应高度重视患者的流行病史,提高组织胞浆菌的检出。
[Abstract]:Objective to investigate the laboratory and clinical diagnosis and treatment of histiocytoplasmosis, and to provide experience for reducing the rate of missed detection and mortality of histiocytoplasmosis. Methods the clinical data of two cases of pulmonary histiocytosis caused by histoplasmosis perfringens were investigated, and the epidemiological history, treatment principles and efficacy of these patients were analyzed. Results both patients were exposed to histiocytoplasmic bacteria, and itraconazole was effective in both patients after 4 months of treatment. After 10 days of incubation in the fungal incubator of Zabro medium, the two patients grew tiny, white and dry colonies, and the two patients were treated with itraconazole for 4 months. Blood Agar grew yeast-like colonies after 20 days in ordinary incubators. Tissue specimens were shredded and smears were smeared. Macroconidial fungi with tubular and columnar protuberances were detected by silver hexamine staining. The secondary colonies grew through gossypol lactic acid. Gram staining showed that there were tubular and columnar protrusions on the surface of 50% of the typical macroconidial spores. Conclusion the culture of histiocytoplasmic bacteria is difficult and the time is long. It is suggested that the culture and identification of histiocytoplasmic bacteria should be considered in the laboratory. Medical laboratory and clinical should attach great importance to the epidemic history of patients and improve the detection of histiocytoplasmic bacteria.
【作者单位】：西安交通大学医学院附属3201医院检验科;西安交通大学医学院附属3201医院呼吸科;北京协和医院检验科;西安交通大学医学院免疫与病原菌系;
【基金】：陕西省自然科学基础研究计划基金项目(2012JM4025)
【分类号】：R519

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