Two Cases Of Disseminated Histoplasmosis And Literature Review

Objective: To analyze the diagnosis and treatment of two patients with disseminated histoplasmosis in the First Affiliated Hospital of Guangxi Medical University,and to review the case data of histoplasma in Guangxi,and to compare the domestic infections at the same time.To explore and summarize the clinical characteristics,histopathology,pathogenic culture,clinical diagnosis and treatment process,differential diagnosis and treatment and outcomes of the disease,deepen the understanding of the diagnosis and treatment of histoplasmosis,to reduce missed diagnosis and misdiagnosis.Methods: To collect HIV-negative disseminated histoplasmosis diagnosed in n our hospital,and to retrospectively analyze the histoplasmosis in Guangxi by searching the cases in the database from 2000 to 2018 in mainland China.Clinical data and reported cases in mainland China,the clinical characteristics,histopathological manifestations,pathogen culture,treatment and outcomes were summarized.Result: From 2000 to 2018,a total of 2 cases of HIV-negative disseminated histoplasmosis were diagnosed in our hospital,and one case was published.In addition,15 cases of histoplasmosis were found in Guangxi.A total of 608 caseswere reported in other provinces and cities in China.All patients were diagnosed by histopathology or culture,some patients were diagnosed by two methods.Among the 17 patients in Guangxi,12 were male.the age of diagnosis was4-70 years old,the occupation was mostly workers,and 5 patients were infected with HIV.Most patients had fever(94%).Other symptoms included hepatosplenomegaly,pulmonary infiltration,skin and mucosal damage.The results of laboratory blood examination varied greatly.One patient had a unique blood picture change with progressive thrombocytopenia.Chest imaging is dominated by patchy and nodular shadows.Twelve patients(71%)were misdiagnosed as respiratory diseases such as tuberculosis and pneumonia.The bacteria were found in 18 cases by histopathology(1 case was found in lymphnodes and bone marrow at the same time),of which bone marrow biopsy(50%)was predominant,4 cases were confirmed by culture,and 2 cases were diagnosed by molecular diagnosis.Twelve patients received antifungal treatment,amphotericin B combined with itraconazole was the most common(42%).Except for 1 case who gave up treatment and 1 case died,the others were all better.the other ones improved;the other 5 patients were unknown,2 died,3 The prognosis is unknown.A total of 608 cases were collected in China,including 416 males.Occupational conditions and underlying diseases were varied,including 64 cases(11%)of HIV infection and age fluctuations of 4-70 years.Most patients(82.9%)developed fever,and other clinical symptoms were complex and variable.74cases(12.2%)had rare skin lesions and mucosal involvement.Histopathological confirmed cases(598 cases)were far more than cultured ones(57 cases).Histopathologic specimens mainly came from bone marrow(58.7%),and the molecular diagnosis was 5 cases(including 2 patients in this study).254 caseswere treated with itraconazole(33.9%)and amphotericin B(31.9%).446 patients had follow-up records,and 383(85.9%)patients had improved symptoms.Conclusion:(1)Although the disease is rare in Guangxi,clinicians should pay attention to and improve the understanding of the disease to reduce missed diagnosis and misdiagnosis.(2)The disease is easy to imitate the onset of various system diseases,laboratory and imaging characteristics are not typical,clinically consider infectious diseases,repeated antibiotic treatment is not effective,suspected fungal infection,especially patients have environmental susceptibility factors and When there is immunosuppression,you should be alert to histoplasmosis infection.(3)All patients in Guangxi were found to have histoplasma by histopathology.It should be distinguished from the endemic fungal disease of Talaromyces marneffei.Effective histopathology and culture were used as early as possible to improve the diagnostic rate.The special fungal staining can help to find the microscopic morphology.The tissue culture is taken from multiple parts,multiple tubes,and placed at different temperatures to extend the culture period for 3-6 weeks.(4)At present,the diagnostic methods are relatively single,and more rapid and accurate detection methods are needed.In the P3 laboratory where conditions permit,the molecular diagnosis can be improved,and the hematuria cytoplasmic antigen test can be performed to assist in diagnosis.(5)Antifungal therapy with amphotericin B and itraconazole can improve the prognosis of patients.