Objective: To investigate the clinical and imaging characteristics of acute histoplasmosis. Methods: The clinical and imaging data of 10 patients with acute histoplasmosis were studied. Their clinical and imaging characteristics were analyzed. All the patients returned from a South American republic in April 2019 and were treated at the Chongqing public health medical treatment center. Results: All the 10 patients were male, aged 30-56 years old, with an average age of 43.8 years old. Four of them were engaged in soil clearing, 2 in gas cutting, 2 in moving tools, and 2 in inspection. The disease in all the 10 patients was caused by inhaling a large amount of bacteria-bearing dust in a short time, with an incubation period of 9-13 days, and the main clinical manifestations were fever, insomnia, dizziness, headache, cough, poor appetite, rash and diarrhea. One patient's head CT showed extensive thickening and increased density of bilateral frontotemporal, parietal and occipital meninges, while the other 9 patients showed no obvious abnormalities. Chest CT findings were as follows: (1) Multiple nodular shadow: the chest CT findings of 4 patients were miliary nodular shadow with diffuse distribution in both lungs. Most of the nodules were less than 5 mm in diameter and distributed evenly or unevenly. CT findings of 6 cases showed scattered nodular shadows in both lungs, with diameters ranging from 2 to 15 mm, and obvious distribution in subpleural and inferior lobes of both lungs. (2) Consolidation shadow: in 2 cases, the size of the shadow was uneven and the density increased, mainly distributed in the subpleura and the lower lobe of both lungs. (3) Ground glass density shadow: mainly distributed around nodules, halo signs can be seen around some nodules. (4) Mediastinum and/or hilar lymph nodes were enlarged. (5) Pleural effusion: a small amount of pleural effusion was found in 4 cases. (6) Pericardial effusion in 3 cases. Abdominal CT showed splenomegaly in 8 cases and hepatomegaly in 1 case. Conclusions: Acute histoplasmosis has no specificity in clinical manifestations. However, there are still some features in CT manifestations, including multiple nodules in both lungs accompanied by halo, enlarged liver, spleen and mediastinal lymph nodes, and multiple serous cavity effusions.
目的： 探讨急性组织胞质菌病的临床与影像学特征。 方法： 对2019年4月从南美某共和国回国，并于重庆市公共卫生医疗救治中心诊治的10例集体发病的急性组织胞质菌病患者的临床及影像学资料进行分析，总结急性组织胞质菌病的临床与影像学特征。 结果： 10例患者均为男性，年龄30~56岁，平均43.8岁；其中4例从事清理积土工作，2例气割作业，2例搬运工具，2例巡视。10例患者均为短时间内大量吸入带菌粉尘而致病，潜伏期9~13 d，以发热、失眠、头昏、头痛、咳嗽、纳差、皮疹、腹泻为主要临床表现。1例患者头颅CT表现为双侧额颞顶枕叶脑膜广泛增厚、密度增高，其余9例未见明显异常。胸部CT表现为：（1）多发结节影：4例胸部CT表现为双肺弥漫性分布粟粒结节影，结节直径大多<5 mm，分布均匀或不均；6例胸部CT表现为双肺散在分布结节影，直径2~15 mm，以胸膜下及双肺下叶分布明显。（2）实变影：2例表现为大小不一斑片状密度增高影，主要分布在胸膜下及双肺下叶。（3）磨玻璃密度影：主要分布于结节周围，部分结节周围可见晕征。（4）纵隔和（或）肺门淋巴结均有肿大。（5）胸腔积液：4例少量胸腔积液。（6）3例心包积液。腹部CT发现脾脏肿大8例，肝脏肿大1例。 结论： 急性组织胞质菌病临床表现无特异性。CT表现上有以下特点：双肺多发结节影伴晕征，肝、脾、纵隔淋巴结肿大，多浆膜腔积液。.
Keywords: Acute disease; Disease attributes; Histoplasmosis.