ObjectiveTo explore the clinical characters, diagnosis and treatment of Penicilliosis marneffei (PSM) in healthy hosts.
MethodsThe clinical data of three cases of PSM involving the lung, bronchus and pleura in healthy hosts were retrospectively analyzed, and the case reports of Penicillium marneffei (PM) infection in healthy hosts were summarized by searching database for related articles, with "Penicilliosis marneffei" as key word both in English and Chinese literatures.
ResultsThe main clinical manifestations of three PSM patients included fever, cough, lymphadenopathy, and elevated white blood cell counts.Series of chest computed tomography of three cases demonstrated atypical and extensive lung lesions.The fiberoptic bronchoscopy of the 2nd case showed several irregular nodules on the bronchial wall.The thoracoscopy of the 3rd case showed much pleural adhesions and small nodules on visceral and parietal pleura.Final diagnosis of PSM was confirmed by the fungal culture, and all patients received antifungal treatment.The symptoms relieved on medication but reoccurred on discontinuation.Literature review identified 36 cases of PSM in healthy hosts.The main clinical features were fever, cough/expectoration, skin rash/skin abscess and elevated white blood cell counts.The most common used antifungal drug was amphotericin B alone or combined with traconazole.The thoracic radiological imaging showed that roughly half of them had clearly thoracic lesions (20/36, 55.65%), and the pulmonary inflammatory infiltrate shadow was most common.Seventeen cases (47.22%) were misdiagnosed as tuberculosis.
ConclusionsPulmonary involvement is common in healthy hosts with PSM and the thoracic radiological features are variable and unspecific, so PSM is easy to be misdiagnosed as tuberculosis.The PSM patients need a longer treatment than other fungal infections.
Pleuropulmonary blastoma (PPB) is a kind of rare malignancy which often occurs in children and is related to dysplasia. It always involves in pleura and lung. PPB is misdiagnosed easily because of its special pathophysiological characters and complex biological behavior. Early detection and correct treatment are very important for thoracic surgeon to cure PPB. This paper reviews the advance of pathophysiological characters, molecular genetic characters, clinical manifestation, clinical diagnosis and differential diagnosis, and treatment and prognosis of PPB.
Objective
To comprehensively observe, recognize, learn and understand the clinical features of tuberculous meningitis (TBM).
Methods
We retrospectively analyzed the general data, clinical manifestations, clinical examinations and treatment prognosis of 152 patients with TBM who were hospitalized in the Second Affiliated Hospital of Zunyi Medical College between January 2016 and February 2017.
Results
The mean age of the 152 patients with TBM was (43.9±20.4) years old, the ratio of male to female was 1.45:1, and the average length of hospital stay was (20.0±18.9) days. The clinical manifestations were mainly headache [95.4% (145/152)], nausea and vomiting [42.8% (65/152)], and fever [61.8% (94/152)]. The main co-morbidities were secondary pulmonary tuberculosis [52.0% (79/152)], hematogenous disseminated tuberculosis [37.5% (57/152)], and tuberculous pleurisy [30.9% (47/152)]. The positive rate of γ-interferon release test was 90.8% (129/142), and the brain pressure of lumbar puncture was elevated. The typical biochemical changes of cerebrospinal fluid were " low glucose, low chlorine, and high protein”. The positive rate of tuberculosis smear was extremely low, and the positive rate of GeneXpert MTB/RIF in cerebrospinal fluid was 21.9% (7/32). The TBM patiens were prone to combine with hypoproteinemia, the proportion reached 29.6% (45/152), and the proportion of hyponatremia reached 45.3% (69/152). Treated with early diagnosis and treatment, 92.1% (140/152) improved and discharged.
Conclusions
TBM patients are mainly young and middle-aged with various clinical manifestations and less respiratory symptoms; and are easy to be combined with pulmonary tuberculosis and other extrapulmonary tuberculosis. γ-interferon release test and cerebrospinal fluid GeneXpert MTB/RIF can be used for the auxiliary diagnosis of tuberculosis. Early detection, early diagnosis and treatment, rational and regular chemotherapy, strengthening symptomatic supportive treatment, and improving the precise diagnosis and treatment of TBM, can improve its clinical prognosis.
Myasthenia gravis (MG) is an autoimmune disease characterized by autoantibody-mediated acquired neuromuscular junction transmission disorders. Based on the different muscles involved, approximately 80% MG can be classified into ocular MG (OMG) and generalized MG. Eighty percent of MG patients initially present with OMG, leading to ptosis and diplopia, which significantly impair their quality of life. Approximately 50.0% to 69.7% of OMG patients may progress to generalized MG within two years, exhibiting symptoms such as limb weakness, dysphagia, and even respiratory failure that threatens life. Due to the diverse manifestations and fluctuating symptoms of OMG, it is often prone to missed and/or misdiagnosis. To further standardize the understanding of OMG among clinicians, Neuro-Ophthalmology Group of Ophthalmology Branch of Chinese Medical Association, Neuro-Ophthalmology Society of Chinese Research Hospital Association, in conjunction with relevant domestic and international researches, consensuses, guidelines and based on the actual situation in China, have developed the Chinese expert consensus on the clinical diagnosis and management of ocular myasthenia gravis (2025). The consensus comprehensively covers clinical diagnosis and management of OMG, including epidemiology, mechanisms of ocular extraocular muscle involvement in MG, clinical manifestations, auxiliary examinations, diagnosis, differential diagnosis, treatment, assessment and prevention strategies for generalized transformation of OMG, and diagnosis and management of refractory OMG, with detailed recommendations provided in nine sections. This consensus is applicable to ophthalmologists, neuro-ophthalmologists, neurologists, and medical personnel engaged in the diagnosis and management of OMG. It aims to standardize the diagnosis and management process of OMG, improve early identification and treatment capabilities, alleviate ocular symptoms of OMG and reduce the risk of generalized transformation.
