马尔尼菲青霉菌感染  

Infection of penicillium Marneffei

作　　者：卢朝辉[1] 刘鸿瑞[1] 谢秀丽[2] 王爱霞[3] 刘彤华[1] 

机构地区：[1]中国医学科学院中国协和医科大学北京协和医院病理科,100730 [2]中国医学科学院中国协和医科大学北京协和医院检验科,100730 [3]中国医学科学院中国协和医科大学北京协和医院感染科,100730

出　　处：《中华病理学杂志》2004年第6期536-540,共5页Chinese Journal of Pathology

摘　　要：目的　探讨马尔尼菲青霉菌感染的病因学、病理组织学、临床特点及鉴别诊断等 ,以期提高疾病的发现及治愈率。方法　对 1例马尔尼菲青霉菌感染病例组织行HE、PAS、Giemsa、六胺银染色观察及病原学培养 ,并对文献进行复习。结果　复习文献报道 2 7例 ,其中合并AIDS感染者 10例 ,合并其他疾病者 5例。马尔尼菲青霉菌为温度敏感的双相真菌 ,可感染健康人或免疫力低下人群 ,首发症状常常为肺部感染或淋巴结病 ,感染可为局限性或全身播散 ,可累及肠道、软组织、骨、肝、脾及骨髓等 ,分别引起相应的临床症状。病理组织学可分别呈肉芽肿型、化脓型及无反应 /坏死型等类型 ,酵母样真菌主要存在于巨噬细胞胞质内 ,可用PAS、Giemsa或六胺银染色显示 ,病原学培养见到酒红色色素可以确诊。结论　如怀疑患者为结核病但无确切证据 ,患者伴有贫血 ,抗结核治疗无效且患者有东南亚地区生活史者 ,应考虑马尔尼菲青霉菌感染。另外 ,要注意同组织胞质菌病的鉴别。疾病早期及时使用抗真菌治疗可治愈。Objectives To elucidate the etiology, pathohistology, clinical characteristic and differentiatial diagnosis, reduce missed diagnosis and improve the early detection and treatment of Penicillium Marneffei infection, by means of this case report and literature review Methods A patient hospitalized Penicillium Marneffei infection were presented here, together with 27 cases in the literature, among which 10 patients had complications of AIDS and 5 with other diseases Results Penicillium Marneffei is a temperature sensitive, two phase fungus, which can infect healthy and immunocompromised subjects The common symptoms are lymphadenopathy and infection of the lung The infection may be local or diffuse, involving the intestinal tract, soft tissue, bone, liver, spleen and bone marrow etc The lesion can be classified into the granuloma type, suppurative type and anergy/necrosis type histologically The yeast like fungus were mainly found in the cytoplasm of macrophages, which were demonstrated by PAS and Giemsa staining The wine red color developed on the culture confirms the diagnosis Conclusions The diagnosis of Penicillium Marneffei infection should be considered when tuberculosis is suspected but not confirmed, and if the patient has a history of having lived or traveled in Southeast Asia, is anemic or resistant to anti tuberculosis treatment The major differentiatial diagnosis is histoplasmosis Early administration of anti fungus drugs is essential for recovery

关 键 词：马尔尼菲青霉菌感染 患者 银染色 疾病 病理组织学 病原学 抗真菌治疗 应考 培养 复习 

分 类 号：R519[医药卫生—内科学]