Retrospective Analysis Of The 367 Pathological Diagnosis In Infectious Granuloma

ObjectiveTo retrospectively analyze the case data of patients with infectious granuloma diagnosed by pathology in our hospital in the past 7 years.MethodsCheck the pathologically diagnosed patients with infectious granuloma from Janu-ary2016 to December 2022 in the medical record system of the pathology de-partment of Guangdong Dermatology Hospital,and check the basic information and clinical information of the patients in the outpatient and inpatient systems according to the table designed in the previous period,and make a return visit-by telephone The patients’ satisfaction with treatment and prognosis were car-ried out,and the data were collected and sorted out for comparative analysis.ResultsA total of 367 patients with pathologically diagnosed infectious granulomas wer-e included,including 185 cases of infectious granulomas with unknown pathoge-ns and182 cases of clearly diagnosed infectious granulomas,of which 57 cases were diagnosed as chromoblastomycosis and 12 cases were diagnosed as spor-otrichosis.There were 5 cases of majocchi granuloma,38 cases of atypical myc-obacterium,3cases of skin tuberculosis,60 cases of leprosy,4 cases of Candi-da infection,2 cases of Aspergillus infection,and 1 case of Nocardia brasiliensis infection.In this study,142(38.7%)patients were able to identify the pathogenic bacteria through pathogen culture,PCR detection,macrogene detection and other tests,40 leprosy patients were diagnosed through epidemiological history and clinical manifestations,and the remaining 185(50.4%)patients had unknown etiology,but combined with medical history,clinical manifestations and pathological results,the clinical diagnosis was infectious granuloma.The male to female ratio of 367 cases of infectious granuloma was 1.3:1,the average age of the patients was(49.3 ± 18.6)years old,and the patients aged 30-60(including 30 years old)were the main infected population,accounting for51.2%;80 There was a statistically significant difference in age between the 102 cases of fungal granuloma with clear pathogenic bacteria and 102 cases of bacterial granuloma with clear pathogenic bacteria,but no statistical difference in gender.The incidence of Mycobacterium tuberculosis is on the rise,while Mycobacterium leprae infection is on the decline year by year.The main cause of infectious granulomas is still trauma(26.7%),and in recent years,the history of trauma related to medical cosmetic filling injections has gradually increased.In the 367 patients in this study,the main infection sites were extremities(71.4%),followed by head and neck(15.3%),and trunk(13.4%).The detection rate of infectious granulomatous pathogenic bacteria was 38.7%.In some patients,the results of pathogenic bacterial culture and PCR test were negative but the results of mngs were positive.Epidermal pseudoepithelial tumor-like hyperplasia and epidermal neutrophil infiltration are more common in fungal granuloma pathological tissue than in tuberculous granuloma,and the dermal inflammatory cell infiltration pattern is mostly diffuse infiltration of neutrophils,lymphocytes,and plasma cells.Tuberculous granulomas are mostly focal infiltration of lymphocytes and epithelioid cells.In 57 cases of chromoblastomycosis,75.4% of the pathological tissues showed characteristic brown sclerenchyma spores,while no pathogen was found in the pathological tissues of sporotrichum,and the positive rate of PAS staining in the pathological tissues of chromoblastomycosis(89.7%)was higher than that of High(57.1%).Fungal granuloma and tuberculous granuloma are often confused at the first clinical diagnosis,while in the diagnosis of non-infectious granuloma,infectious granuloma is most likely to be misdiagnosed as skin tumor,accounting for about one-third of the first diagnosis(28.7%),in addition to some connective tissue diseases,lichen planus,pyoderma gangrenosum.For patients with unidentified pathogenic bacteria but with epidemiological history and clinical manifestations,and pathological diagnosis consistent with infectious granuloma,27cases(60%)of 45 patients who only underwent surgical resection could completely regress,and those who could not be completely resected by surgery were given empiric antibiotics After treatment,72 cases(54.5%)of patients were better than before;the treatment options for fungal granulomas such as chromoblastomycosis,sporotrichosis and majocchi were mostly oral itraconazole and terbinafine alone or in combination,of which 37 of 57 patients with chromoblastomycosis improved after antifungal treatment(64.9%),5 of 12 patients with sporotrichosis(41.7%)improved after treatment,and 4 of 5 patients with majocchi granulomatosis improved after treatment(80%)cases,the treatment options for Mycobacterium tuberculosis infection were varied,and the most used drugs were clarithromycin(27 cases,71.1%)and rifampicin(24 cases,63.2%),including clarithromycin,levofloxacin combined with rifampin,clarithromycin combined with levofloxacin,rifampicin combined with levofloxacin,and the rest were treated with anti-tuberculosis alone,antibiotics alone or combined with antibiotics and anti-tuberculosis drugs.Of the 38 cases,25 cases were improved or cured(65.7 %).ConclusionIn the past 7 years,the incidence of infectious granuloma in our hospital has shown an overall upward trend year by year,among which atypical mycobacterial infection has an obvious upward trend;the infectious granuloma with clear pathogenic bacteria is mainly fungal granuloma and tuberculous granuloma,fungal granuloma Granulomas were dominated by chromoblastomycosis,and tuberculous granulomas were dominated by atypical mycobacteria;It is difficult to confirm the diagnosis of infectious granuloma,and it is easy to miss the diagnosis only by etiological culture and PCR detection.m NGS is of great significance for the clear diagnosis;it is meaningful to give empiric antibacterial treatment to patients with unclear etiology but highly suspected infectious granuloma.