Clinical characteristics of 20 patients with histoplasmosis in a first A tertiary hospital in Hunan Province and literature review
Objective To analyze the clinical characteristics of patients with histoplasmosis(HP)in one tertiary general hospital in Hunan Province,with a view to providing references for the diagnosis and treatment of histoplasma infection.Methods The epidemiological and clinical data of patients with HP in a tertiary general hospital in Hunan Province from January 2013 to June 2023,were retrospectively analyzed.Results A total of 20 cases of histoplasma infections were diagnosed.Among them,pulmonary histoplasmosis was found in 4 cases and disseminated histoplasmosis in 16 cases.The age of onset of the disease was clustered between 14 and 60 years(16 cases,80％).Eleven patients lived in rural areas(55％),and there were 4 cases of immunodeficiency diseases(20％).Four patients with pulmonary HP had mild respiratory symptoms.A total of 16 patients with disseminated HP presented complex clinical manifestations,including systemic symptoms such as fever as well as dysfunction of multiple organs,including the lungs,liver,gastrointestinal tract,and skin.Eighteen patients(90％)were diagnosed by biopsy of the lungs,bone marrow,and intestinal mucosa,and two were diagnosed by metagenomic next generation sequencing(mNGS)combined with tissue biopsy.A total of 17 patients(85％)were treated with antifungal therapy and had a good prognosis,and 1 patient with disseminated HP had a relapse due to an insufficient course of anti-infection treatment.Conclusions The clinical manifestations of histoplasmosis lack specificity,leading to a high rate of misdiagnosis.The new techniques,such as mNGS,can improve the detection rate of HP.Pharmacotherapy should be tailored to the type and severity of the disease with antifungal agents,such as amphotericin B or azole,with appropriate courses of administration.
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