PDF(Pubmed)
Abstract：
Background: A miliary pattern on chest imaging is often attributed to tuberculosis (TB) infection. However, a myriad of conditions can cause a miliary pattern, many of which are imminently life-threatening. Research Question: The primary aim of our study is to elucidate the potential causes of miliary chest imaging patterns to improve workup and empiric therapy selection. The secondary aims are to discern the predictors of miliary disease etiology and to determine whether appropriate empiric antimicrobial therapies were given. Study Design and Methods: In this retrospective cohort study, we searched a radiology database for patients with chest imaging studies described by the word \"miliary\". Subjects were excluded if they were under 18 years of age and if there were insufficient objective data to support a miliary disease etiology. A radiologist independently reviewed all imaging studies, and studies that did not appear to have a true miliary pattern were excluded. The collected data include patient demographics, immunocompromising risk factors, conditions associated with miliary disease, β-D-glucan levels, serum eosinophil count, and empiric therapies received. Results: From our 41-patient cohort, 22 patients (53.7%) were clinically diagnosed with coccidioidomycosis, 8 (19.5%) with TB, 7 (17.1%) with metastatic solid cancer, 1 (2.4%) with lymphoma, 1 (2.4%) with other (Mycobacterium simiae), and 3 (7.3%) with unknown diseases (the sum equals 42 patients because one individual was diagnosed with both coccidioidomycosis and TB). All six patients with greater than 500 eosinophils/μL were diagnosed with coccidioidomycosis. Of the 22 patients diagnosed with coccidioidomycosis, 20 (90.91%) were empirically treated with an antifungal regimen. Of the eight patients with TB, six were empirically treated for TB. Interpretation: Based on our data from a Coccidioides-endemic region with close proximity to tuberculosis-endemic areas, the leading cause of miliary disease is coccidioidomycosis, although TB and cancer are also common etiologies. Serum eosinophilia and elevated β-D-glucan levels were strongly predictive of coccidioidomycosis in our patient cohort with a miliary chest imaging pattern.
摘要：
背景：胸部影像学上的网状图案通常归因于结核病（TB）感染。然而,无数的条件可能会导致一个milsiary模式，其中许多威胁生命。研究问题：我们研究的主要目的是阐明立体胸部成像模式的潜在原因，以改善检查和经验性治疗选择。次要目的是辨别粟粒病病因的预测因素，并确定是否给予适当的经验性抗微生物疗法。研究设计和方法：在这项回顾性队列研究中，我们在放射学数据库中搜索了用"milsiary"一词描述的胸部影像学研究患者.如果受试者年龄在18岁以下，并且没有足够的客观数据来支持杂性疾病的病因，则将其排除在外。放射科医生独立检查了所有的影像学检查,和研究似乎没有一个真正的milsiary模式被排除。收集的数据包括患者的人口统计，免疫受损的危险因素，与粟粒性疾病相关的条件，β-D-葡聚糖水平，血清嗜酸性粒细胞计数，和经验性治疗。结果：从我们的41名患者队列中，22例(53.7%)临床诊断为球孢子菌病,8（19.5%）与TB，7例（17.1%）转移性实体癌，1例（2.4％）患有淋巴瘤，1（2.4％）与其他（猿类分枝杆菌），3例（7.3％）患有未知疾病（总和等于42例患者，因为一名患者被诊断患有球孢子菌病和TB）。所有6例嗜酸性粒细胞大于500/μL的患者均被诊断为球孢子菌病。在被诊断为球孢子菌病的22例患者中，20例(90.91%)采用抗真菌方案进行经验性治疗。在8名结核病患者中，6例接受了结核病的经验性治疗.解释：根据我们的数据，该数据来自靠近结核病流行区的球虫流行区，菌丝病的主要原因是球孢子菌病，虽然结核病和癌症也是常见的病因。在我们的患者队列中，血清嗜酸性粒细胞增多和β-D-葡聚糖水平升高是球孢子菌病的强烈预测因素，并具有绒状胸部成像模式。
