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目的深入认识儿童肺隐球菌病的表现、诊断进展、治疗和预后,以提高对儿童肺隐球菌病的诊断和治疗水平,防止发生全身播散。方法回顾分析2005-01—2006-06北京儿童医院收治的免疫功能基本正常的14例肺隐球菌病患儿的临床资料。结果14例患儿最小年龄为1岁8个月。症状主要为长期发热,咳嗽不重或持续时间较短暂。肺部查体12例正常,2例闻及干啰音和中水泡音?级廾飨灾卸局⒆础?例伴有间断腹痛,查体时有肝和(或)脾肿大。从发病到确诊至少23d,最长为5个月。实验室检查:13例外周血白细胞和中性粒细胞升高、C反应蛋白(CRP)明显升高。肺部影像学表现:11例患儿表现为双肺弥漫或散在小结节影,并有胸膜下分布。3例未发生肺外播散,11例伴有肺外隐球菌病(播散性隐球菌病)。病原学检查:8例找到隐球菌孢子。12例进行血清隐球菌荚膜多糖抗原检查,仅1例阴性,其余2例单独肺隐球菌病患儿以及9例播散性隐球菌病患儿全部阳性。动物接触史:6例有接触鸽子史,5例无动物接触史,3例接触家鸡。在11例伴有肺外隐球菌病的患儿中,9例静脉联合应用二性霉素B和氟康唑等治疗,病情控制,改为口服氟康唑继续治疗。1例在确诊前死亡,未行抗真菌治疗。在3例单独的肺隐球菌病患儿中,2例静脉应用二性霉素B;1例静脉应用氟康唑治疗病情控制,改为口服氟康唑继续治疗。结论儿童肺隐球菌病可发生于免疫功能正常的儿童,可无动物接触史,尽管长期发热、外周血白细胞和中性粒细胞升高、CRP升高,无特异性,但临床进展缓慢,咳嗽不重、无明显中毒症状、嗜酸性粒细胞升高,IgE升高是其相对特异的临床表现。双肺弥漫或散在小结节影,和(或)纵隔、肺门淋巴结肿大,为影像学表现。除隐球菌培养外,血肺隐球菌抗原检测有助于诊断。二性霉素B和(或)氟康唑治疗可控制隐球菌病。
Objective To understand the manifestation, diagnosis, treatment and prognosis of children with pulmonary cryptococcosis in order to improve the diagnosis and treatment of pulmonary cryptococcosis in children and prevent the spread of whole body. Methods The clinical data of 14 children with pulmonary cryptococcosis with basically normal immune function admitted from January 2005 to June 2006 in Beijing Children’s Hospital were retrospectively analyzed. Results The minimum age of 14 children was 1 year and 8 months. The main symptoms of long-term fever, cough is not heavy or shorter duration. Pulmonary checkup in 12 cases of normal, 2 cases of dry rales and the smell of water bubble? Level 廾 飨 disaster relief ⒆ base? Cases with intermittent abdominal pain, physical examination when the liver and (or) splenomegaly. From the onset to the diagnosis of at least 23d, up to 5 months. Laboratory tests: Peripheral leukocytes and neutrophils increased in 13 cases, and C-reactive protein (CRP) was significantly elevated. Pulmonary imaging findings: 11 cases of children showed diffuse or diffuse lung nodules, and subpleural distribution. No extrapulmonary disseminations occurred in 3 cases and 11 cases had extrapulmonary cryptococcosis (disseminated cryptococcosis). Etiological examination: 8 cases of cryptococcal spores found. 12 cases of cryptococcal capsular polysaccharide antigen examination, only 1 negative, the remaining 2 cases of children with pulmonary cryptococcosis alone and 9 cases of children with disseminated cryptococcosis were all positive. Animal exposure history: 6 cases had contact with pigeons history, 5 cases without animal exposure history, 3 cases of contact with chicken. In 11 cases of children with extra-pulmonary cryptococcosis, 9 cases of venous combined amphotericin B and fluconazole treatment, disease control, to oral fluconazole continue treatment. One patient died before the diagnosis, not anti-fungal treatment. In 3 cases of children with pulmonary cryptococcosis alone, 2 cases of intravenous amphotericin B; 1 case of intravenous fluconazole treatment of disease control, changed to oral fluconazole continue treatment. Conclusions Childhood pulmonary cryptococcosis can occur in children with normal immune function and may have no history of exposure to animals. Although long-term fever, peripheral blood leukocytes and neutrophils are elevated, CRP is elevated, but not specific, but clinical progression is slow and coughing Not heavy, no obvious symptoms of poisoning, eosinophilia, elevated IgE is its relatively specific clinical manifestations. Diffuse lung or diffuse small nodules, and (or) mediastinum, hilar lymph nodes, imaging performance. In addition to cryptococcal culture, C. pneumoniae antigen testing helps diagnose. Amphotericin B and / or fluconazole therapy can control cryptococcosis.