11例蝇蛆病合并肺嗜酸细胞增多症误诊肺结核原因分析

摘要

目的：：通过对蝇蛆病合并肺嗜酸细胞增多症误诊为肺结核的原因分析，提高对两种疾病的鉴别诊断能力。方法：采用回顾性调查研究的方法，采集2002年2月~2012年12月住院并经临床及实验室检查证实的蝇蛆病合并肺嗜酸细胞增多症误诊肺结核患儿11例，对其病史资料、临床表现、实验室检查、临床治疗及预后进行回顾性分析，找出误诊原因。结果：误诊肺结核的蝇蛆病合并肺嗜酸细胞增多症患者最常见的症状为咳嗽、咳黏痰、胸痛及低热、乏力、盗汗等全身中毒症状，皮下游走性疖肿及匍行疹，病程常超过3周。胸部X线、CT表现多种多样。结论：痰结核菌阴性而临床症状和X线表现与肺结核相似，经正规抗结核治疗后仍反复发作或无效，病程中有游走性疖肿及匍行疹的患者，应考虑到肺嗜酸细胞增多症。%Objective:To improve differential diagnosis ability of myiasis with pulmonary eosinophilia and pulmonary tuberculosis through analyzing the reason of misdiagnosis between myiasis with pulmonary eosinophilia and pulmonary tuberculosis.Methods:Using the method of retrospective study,retrospectively reviewed the medical records of 11 myiasis with pulmonary eosinophilia cases which were confirmed by clinical and lab test and were misdiagnosed as pulmonary tuberculosis from February 2002 to December 2012.Their clinical features, laboratory investigations,treatment and prognosis were analyzed,find out the causes of misdiagnosis.Results:The symptoms of myiasis with pulmonary eosinophilia misdiagnoses as pulmonary tuberculosis including coughing,mild phlegm,chest pain,breathlessness, dyspnea,lowgrade fever,hypodynamia and night sweat,subcutaneous migration furunale and creeping eruption.The duration of the disease was more than three weeks.The thoracicX-ray and CT manifestations were multifarious. Conclusion:The reason of misdiagnosis is lack of knowledge of myiasis with pulmonary eosinophilia.We should be alert to myiasis with pulmonary eosinophilia that sputum examination is negative, in the course of a migration furunale and creeping eruption,clinical symptom and chest X-ray examination is similar as tuberculosis,but relapses or has no effect after regular therapy.