目的总结中国球孢子菌病病例的特点,提高该病的诊断和治疗水平,防止误诊和治疗失误。方法在包括Medline,万方,中国知网以“球孢子菌病”和“中国”为索引词,共发表了23篇文章,共报告了32例中国球孢子菌病病例。此外,2016年4月,我们中心对1例播散性球虫病患者进行了治疗.人口统计数据,感染部位,临床表现,既往病史,曝光历史,成像和实验室发现,并对33例患者的病理特征进行分析。结果33例患者中,7人(21.2%)去过疫区,6人(18.2%)免疫功能低下。该疾病涉及呼吸系统,皮肤,骨头,中枢神经系统,角膜,和胃在24,6,3,2,1和1名患者中,分别。8例患者(24.2%)多系统受累,其中三人死亡。影像学表现包括肺结节(n=14),纵隔淋巴结病(n=5),实体阴影(n=4),腔(n=4),胸腔积液(n=3),多个斑块(n=2)和质量(n=2)。在受影响的组织(n=28)或脓液中检测到球虫囊肿,渗出物或胸膜涂片(n=3);此外,在痰中发现了球虫菌丝体和孢子,脓液,和组织培养4例,其中只有2例经血清学检查证实。治疗包括三唑(n=20),两性霉素B的全身或局部给药(n=13),手术切除病变(n=8),静脉注射丙种球蛋白(n=1)。五名病人死亡,其中三人患有导致免疫抑制的潜在疾病,一人是婴儿。其余患者的预后相对较好。结论早期诊断和正确治疗球孢子菌病可取得良好的预后。多系统参与和免疫抑制是球虫菌病预后不良的危险因素。对于这些患者来说,足量和全程用药可防止疾病快速进展.
Objective To summarize the characteristics of Chinese coccidioidomycosis cases, improve the diagnosis and treatment of this disease and prevent misdiagnosis as well as therapeutic error.Methods Search in databases including Medline,Wanfang,and CNKI using \"Coccidioidomycosis\" and \"
China\" as index words yielded 23 articles that reported a total of 32 Chinese coccidioidomycosis cases.In addition,one patient with disseminated coccidioidomycos was treated in our center in April 2016.The demographic data,site of infection,clinical manifestations,past medical history,exposure history,imaging and laboratory findings,and pathological features of these 33 patients were analyzed.Results Among these 33 patients,7(21.2%)had visited an epidemic area and 6(18.2%)were immunocompromised.The disease involved the respiratory system,skin,bone,central nervous system,cornea,and stomach in 24,6,3,2,1,and 1 patients,respectively.Eight patients (24.2%) had multiple system involvement,and three of them died.The imaging findings included pulmonary nodules(n=14),mediastinal lymphadenopathy(n=5),solid shadow(n=4),cavity(n=4),pleural effusion(n=3),multiple plaques(n=2)and masses(n=2).Coccidiolys cysts were detected in the affected tissues(n=28)or in pus,exudate or pleural smear(n=3);in addition,
coccidioides mycelium and spores were found in the sputum,pus,and tissue cultures in 4 cases,among whom only 2 cases were confirmed by serological examination.The treatments included triazoles(n=20),systemic or local administration of amphotericin B(n=13),surgical resection of the lesion(n=8),and intravenous gamma globulin(n=1).Five patients died,among whom three had underlying diseases that caused immunosuppression and one was an infant.The prognoses were relatively good in the remaining patients.Conclusions Early diagnosis and proper treatment can achieve good prognosis in coccidioidomycosis patients.Multi-system involvement and immunosuppression are risk factors for poor prognosis of coccidioidomycosis.For these patients,adequate and full-course medication may prevent rapid disease progression.