摘要
目的分析2019年4月在南美圭亚那合作共和国集体发病的10例急性组织胞浆菌病中国籍患者的临床特点,总结治疗方案.方法对10例急性组织胞浆菌病患者的住院与随访资料进行分析.结果10例均为青中年男性,年龄30~56岁,平均(44±8)岁;4例从事清理积土工作,2例气割作业,2例搬运工具,2例巡视.暴露时间0.2~96.0 h;潜伏期9~13 d,平均(11±1)d.以发热、头昏、头痛、乏力、纳差、咳嗽、皮疹、腹泻为主要临床表现.胸部CT表现为双肺多发结节影,以胸膜下及双肺下叶分布明显;结节周围可见晕征;少数患者可出现实变影.1例诊断为急性播散型组织胞浆菌病,9例诊断为急性肺型组织胞浆菌病.住院使用两性霉素B脂质体,起始剂量每天0.7~1.2 mg/kg,平均每天(0.8±0.2)mg/kg;最高剂量每天1.1~2.0 mg/kg,平均每天(1.4±0.3)mg/kg.使用时间4~54 d.出院使用伊曲康唑10~161 d、伏立康唑口服治疗5~7个月.9例临床症状消失,1例植物人状态.复查胸部CT显示肺部病灶均明显吸收.结论急性组织胞浆菌病的临床和影像学表现有一定特点.确诊需结合流行病学史、临床、影像、实验室及病理检查.两性霉素B脂质体作为该病中、重度患者的强化治疗药物是有效的,但最高剂量小于美国感染病学会(IDAS)推荐剂量.序贯使用伊曲康唑与伏立康唑治疗均有效.
Objective To analyze the clinical characteristics a cluster of 10 cases of acute histoplasmosis in Cooperative Republic of Guyana,South America in April 2019.Methods The in-hospital and follow-up data of 10 Chinese patients with acute histoplasmosis were analyzed.Results All the 10 patients were young or middle-aged males,30 to 56[average(44±8)]years old.The profession included soil clearing in 4 cases,gas cutting operations in 2 cases,tool-handling in 2 cases,and patrol in 2 cases.The exposure time was 0.2 to 96.0 hours.The incubation ranged from 9 to 13 days,average of(11±1)days.The main clinical manifestations were fever,dizziness,headache,fatigue,poor appetite,cough,rash,and diarrhea.Chest CT showed multiple nodules in both lungs,primarily located in subpleural area and lower lobe of both lungs.Halo signs were seen around the nodules.Lung consolidation was observed in a small number of patients.One patient was diagnosed as acute disseminated histoplasmosis and the other 9 as acute pulmonary histoplasmosis.Amphotericin B liposome was used in hospital.The initial dose ranged from 0.7 to 1.2 mg·kg^-1·d^-1,average of(0.8±0.2)mg·kg^-1·d^-1.The highest dose was 1.1-2.0 mg·kg^-1·d^-1,average of(1.4±0.3)mg·kg^-1·d^-1.The duration of treatment was 4-54 days.After discharge from hospital,itraconazole(for 10-161 days)and voriconazole(for 5-7 months)were administered orally.Clinical symptoms disappeared in 9 cases.The remaining one patient turned to vegetative state.Repeat chest CT confirmed that pulmonary lesions were largely absorbed.Conclusions The clinical and radiographic manifestations of acute histoplasmosis have some characteristics.Diagnosis requires epidemiological history combined with the results of clinical,imaging,laboratory,and pathological examination.Amphotericin B liposome,as an intensive treatment for moderate to severe patients,is effective for Chinese patients,but the maximum dose is lower than the dose recommended by the Infectious Disease Society of American.Sequential treatment with itraconazole and voriconazole is effective.
作者
青刚
严晓峰
杨松
李琦
张绿浪
袁国丹
陈思源
王静
黄贵川
陈懿
王新
郭述良
QING Gang;YAN Xiaofeng;YANG Song;LI Qi;ZHANG Lülang;YUAN Guodan;CHEN Siyuan;WANG Jing;HUANG Guichuan;CHEN Yi;WANG Xin;GUO Shuliang(Department of Respiratory and Critical Care Medicine,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)
出处
《中国感染与化疗杂志》
CAS
CSCD
北大核心
2020年第6期645-651,共7页
Chinese Journal of Infection and Chemotherapy
基金
重庆市医学高端后备人才培养项目(2015HBRC001)。
