Clinical Contrast Study Of Talaromycosis Marneffei With Bone Destruction And Bone Tuberculosis

Objective: The clinical data of TSM patients with bone destruction and bone tuberculosis treated in the First Affiliated Hospital of Guangxi Medical University were retrospectively analyzed to explore the characteristics and differences.Our purpose is to explore the characteristics and differences in the medical history of the two types of patients,so as to provide reference for the differential diagnosis of the two types of patients.Methods: We collected clinical case data of patients with TSM complicated with bone destruction and bone tuberculosis admitted to the First Affiliated Hospital of Guangxi Medical University between July 2018 and July 2020.Retrospectively analyzing general information,clinical manifestations,laboratory examination and imaging examination of the two kinds of patients.Results: We have collected 18 patients who fall in TSM with bone destruction and 42 patients with bone tuberculosis during July 2018 to July 2020.Through the collection and statistical analysis of the clinical data of the two types of patients,we obtained:(1)General situation: among the patients with TSM complicated with osteogenesis,7 cases(38.8%)were female and 11 cases(61.1%)were male,with an age of 53.9±12.7 years.Among the patients with bone tuberculosis,13 cases(30.9%)were female and 29 cases(69.0%)were male.Their age was 46.7±17.6 years old.(2)Clinical manifestations: 13 patients(72.2%)with TSM complicated with bone destruction had fever,including 1 low fever,8 moderate fever and 4 high fever.The fever degree was mainly moderate and high fever.There were cough and expectoration in 16 cases(88.9%),rash and other skin lesions in 8 cases(44.4%),lymph node enlargement or local mass in 6 cases(33.3%).Bone pain occurred in 17 patients(94.4%).Among the patients with bone tuberculosis,9 cases(21.4%)have fever,including 6 cases of low fever,1 case of moderate fever,and 2 cases of high fever.The fever degree was mainly low fever.Neck pain was found in 4 patients(9.5%),chest and back pain in 14 patients(33.3%),lumbar and leg pain in 17 patients(40.5%),and bone and joint pain in the remaining 7 patients(16.7%).6 cases(14.3%)presented fatigue night sweats.(3)Laboratory examination: WBC,neutrophil absolute value,globulin,erythrocyte sedimentation rate was significantly increased in TSM patients with bone destruction,and the clearance rates of RBC,hemoglobin,albumin and creatinine were decreased.The erythrocyte sedimentation rate was elevated in the patients with bone tuberculosis,and other laboratory tests were within the normal range.(4)Imaging examination: 16patients(88.9%)with TSM complicated with bone destruction showed multiple lesions of bone destruction throughout the body,mainly in the sternum,ribs,clavicle,femur,humerus,skull and other long flat bones.Bone destruction occurred in the spine in 38(90.5%)of the patients with bone tuberculosis.Conclusion: TSM with bone destruction patients are different from bone tuberculosis patients in terms of fever proportion,degree of fever,general symptoms,location of bone destruction and blood examination.Compared with the two types of patients,TSM patients with osteopenia had higher fever ratio and fever degree,higher white blood cell and neutrophil values,and lower hemoglobin.And patients have cough sputum,skin lesions,lymph node enlargement symptoms.During we treat a patient who suffer bone destruction,when the therapeutic effect is void after surgery or anti-tuberculosis treatment,we need consider the possibility of TM infection.