背景:胚真菌病是由皮肤胚真菌病引起的真菌感染,在威斯康星州是高流行的。它通常表现为肺部感染,并经常传播到皮肤。评估以皮肤为先兆的芽生菌病的表现和诊断的研究尚未得到彻底评估。了解诊断这种感染的最准确方法对于早期治疗干预很重要。
方法:这是一个单一机构的回顾性图表回顾研究。通过检索ICD-9(国际疾病分类,第九次修订)和ICD-10(国际疾病分类,第十次修订)临床记录和病理数据库中的胚真菌病代码。如果从2009年1月1日至2021年6月1日被诊断为皮肤芽生菌病感染或全身性感染的皮肤受累,则将患者包括在内。
结果:确定了20例诊断为芽生菌病皮肤受累的患者;65%(n=13)为男性。诊断年龄中位数为55.5岁。55%的病人是白人,35%是黑人或非裔美国人。除了居住在流行地区,50%(n=10)有暴露风险因素。50%的患者(n=10)最初出现皮肤问题;65%(n=13)有皮肤外受累。仅通过组织病理学诊断为55%(n=11),35%的文化加组织病理学(n=7),5%(n=1)的病例中单独培养。
结论:我们的研究强调了与以前进行的研究的相似性。一半有芽生菌病皮肤受累的患者(n=10)没有表现出临床上明显的肺部受累。组织病理学和培养在皮肤胚真菌病的诊断中仍然至关重要。
BACKGROUND: Blastomycosis is a fungal infection caused by Blastomyces dermatitidis that is hyperendemic in Wisconsin. It commonly presents as a pulmonary infection and frequently disseminates to the skin. Studies evaluating the presentation and diagnosis of
blastomycosis with skin as a presenting sign have not been thoroughly evaluated, and understanding the most accurate way to diagnose this infection is important for earlier therapeutic intervention.
METHODS: This is a retrospective chart review study of a single institution. Subjects were identified through a search of ICD-9 (International Classification of Diseases, Ninth Revision) and ICD-10 (International Classification of Diseases, Tenth Revision) codes for blastomycosis in the clinical record and pathology database. Patients were included if diagnosed with cutaneous
blastomycosis infection or involvement of the skin from systemic infection from January 1, 2009, to June 1, 2021.
RESULTS: Twenty patients with a diagnosis of cutaneous involvement of blastomycosis were identified; 65% (n = 13) were male. Median age of diagnosis was 55.5 years. Fifty-five percent of patients were White, 35% were Black or African American. In addition to residence in an endemic area, 50% (n = 10) had exposure risk factors. Fifty percent of patients (n = 10) initially presented with a skin concerns; 65% (n = 13) had extracutaneous involvement. Diagnosis was made by histopathology alone in 55% (n = 11), culture plus histopathology in 35% (n = 7), and culture alone in 5% (n = 1) of cases.
CONCLUSIONS: Our study highlighted similarities to those previously performed. Half of the patients (n = 10) who had cutaneous involvement of
blastomycosis did not demonstrate clinically significant pulmonary involvement. Histopathology and culture remain critical in diagnosing cutaneous
blastomycosis.