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播散性组织胞浆菌病是一种罕见病,其确切发病率尚未清楚。据一份最近资料,在流行区的发病率是0.46‰。本文报告的2例,死亡前几年一直生活在非流行区。但他们都曾经在流行区居住或访问过。这2例究竟是先前感染的内源性反应,抑或是外源性反应还不清楚。最初诊断是由骨髓活体组织检查确定,此方法比需要几个星期才能有细菌生长的真菌培养法快速和具有特异性。第2例为真菌性腹膜炎继发播散性组织胞浆菌病,是由腹透出液培养和尸体解剖确诊。据作者所知,是持续性非卧床腹膜透析病人中首次报道。其唯一的症状是腹痛、腹透出液单核细胞增多和真菌感染的症状。
Disseminated histoplasmosis is a rare disease whose exact incidence is not yet known. According to a recent data, the prevalence in endemic areas is 0.46 ‰. Two cases reported in this article have been living in non-endemic areas for a few years prior to their death. But they all lived or visited the popular area. Whether these two cases of endogenous or previous exogenous reactions, or extrinsic reactions is unclear. The initial diagnosis was confirmed by bone marrow biopsy, which is faster and more specific than the fungal culture that takes several weeks to grow bacteria. The second case of fungal peritonitis secondary disseminated histoplasmosis is diagnosed by abdominal dialysis culture and autopsy. To the author’s knowledge, it is the first reported in continuous ambulatory peritoneal dialysis patients. The only symptoms are abdominal pain, dialysate mononucleosis and fungal infection symptoms.