| Objective: To analyze and summarize the clinical characteristics,diagnosis,treatment and prognosis of acute histoplamosis(HP)of imported type group,so as to improve the level of diagnosis and treatment of this rare disease in the acute stage.Methods: The hospitalization records and follow-up data of 10 patients with acute histoplasmosis who developed in the cooperative republic of Guyana,South America in April 2019 were collected,and the clinical characteristics,diagnosis and treatment were retrospectively analyzed.Results:(1)General conditions: all the 10 cases were male,aged30-56 years old,with an average of(44±8)years old.Case 7 had been cured of tuberculosis and was now suffering from gastroesophageal reflux.The other 9 cases had no chronic underlying diseases.The work of 4 cases was soil clearing,2 cases were gas cutting,2 cases were carrying tools,2cases were inspection.The exposure time ranged from 0.2 to 56 hours,with an average of(20±23)hours.(2)Clinical manifestations: the incubation period was 9 ～ 13 days,with an average of(11±1)days;The main clinical symptoms were fever,dizziness,headache,fatigue,poor appetite,cough,rash and diarrhea.The main signs are lung rales and spleen enlargement.(3)Imaging features: Chest CT showed multiple nodules in both lungs,mostly distributed in the subpleura and the lower lobes of both lungs,halo signs could be seen around the nodules,and realistic shadows could be seen in a few patients.(4)Laboratory examination: Histocytoplasmic bacteria were isolated from the blood culture of Case 1 and bronchoalveolar lavage fluid culture,while no positive findings were found in the blood culture,sputum culture,bone marrow smear and culture of the other patients.The detection of histoplasmic antigen in urine was positive in all 10 patients,and the detection of serum antibody against histoplasmic antigen was positive 1.5months after onset.Case 1 bronchoalveolar lavage fluid(BALF)was sent to CDC in Chongqing for PCR and gene sequencing.Histocytoplasmic specific nucleic acid fragments were detected.Case 1 underwent TBCB surgery.Histological examination showed multifocal histiocytic hyperplasia and granulomatous changes,with small necrosis,serous fluid and fibrin exudation in some alveolar cavities,and capillary blood congestion in local alveolar walls.Special staining: PAS(-),hexamine silver(-),and acid-fast staining(-).Immunohistochemistry: CK alveolar epithelium(+),CD68 tissue cells(+),CD163 tissue cells(+).(5)Diagnosis:Case 1 was diagnosed with acute disseminated histoplasmosis and Case2-10 was diagnosed with acute pulmonary histoplasmosis.(6)Treatment:intravenous infusion of amphotericin B liposome,starting dose 0.7 ～1.2mg/kg per day,average(0.8±0.2)mg/kg per day;The highest dose was1.1 ～ 2.0mg/kg/day,with an average of(1.4±0.3)mg/kg/day.The use time is 4 ～ 54 days,with an average of(14±14)days.After discharge,itraconazole and voriconazole were taken orally for 7 months.(7)Results:Case 1 presented vegetative state,and clinical symptoms disappeared in Case 2 ～ 10.The lesions in chest CT reexamination of all cases were obviously absorbed.After 3.5 months of antifungal treatment,the histoplasmouria antigen turned negative.Conclusion: Acute histoplasmosis capsulatum can be diagnosed effectively by comprehensive epidemiological history,clinical,imaging,laboratory and pathological examination.Amphotericin B liposome was found to be effective in Chinese as an intensive treatment for moderate and severe patients with this disease.However,the recommended dose of amphotericin B liposome could not be tolerated in all cases.Both the sequential use of itraconazole and voriconazole were effective,with voriconazole having less side effects than itraconazole. |
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