艾滋病合并播散性马尔尼菲青霉菌感染临床及治疗转归研究  

Study on disseminated Penieillum marneffei infection associated with AIDS, report of eight cases,treatment and prognosis

作　　者：刘艳[1] 詹能勇[1] 李慧涓[1] 蒋小玲[1] 乐晓华[1] 朱文科[1] 蔡力生[2] 黄华[1] 

机构地区：[1]深圳市东湖医院,518020 [2]深圳市第二人民医院血液科

出　　处：《中华传染病杂志》2005年第4期256-259,共4页Chinese Journal of Infectious Diseases

摘　　要：目的探讨艾滋病(AIDS)合并播散性马尔尼菲青霉菌病(PSM)临床及实验室检查的特征,提高对本病认识,分析治疗及预后。方法分析我院1999年以来确诊的8例AIDS合并PSM的临床资料。结果8例患者临床主要表现发热、口腔黏膜白斑、浅表淋巴结肿大、丘疹性皮损、贫血、腹痛、肝肿大、脾肿大、生殖器疱疹、皮下结节、剧烈骨痛。实验室检查转氨酶升高、凝血功能异常、血细胞减少。胸片表现不典型,主要以间质性或实质性病变为主。真菌培养:在37℃培养或组织中马尔尼菲青霉菌呈酵母型,组织细胞外真菌长,弯曲,有横膈的腊肠状;在25℃培养中呈菌丝型,并产生红色色素扩散入培养基中。CD4明显减少,HIV RNA值高。结论AIDS合并PSM临床表现无典型特征,培养真菌可产生红色色素,可见有横隔的腊肠状细胞,见典型帚状枝。合并PSM是免疫功能极度低下所致感染。两性霉素B治疗有效。Objective To explore the clinical and laboratory feature of disseminated Penicillium marneffei（PSM） infection in patients with AIDS and to analysis treatment and prognosis. Methods Study clinical data of eight case with PSM infection in patients with AIDS in our hospital from 1999 were definite diagnosed PSM infection in patients with AIDS. Results （1）Fight patients including five females, at a mean age of 26-53, suffered from the diseases for a period of 1-4 months;（2）The most common clinical presentations include fever, stomatomycosis, lymphadenectasis papular skin le sion, anemia, abdominal pain, hepatomegaly, Plenomegaly, Herpes progenitalls, Subcutaneous nod ule, Pleural effusion, bad bone ache. Laboratory examination showed elevated hepatic enzymes,coagulated dysfunction, hemocytopenia. Chest X ray showed nonspecific include bilateral interstitial or alve olar. （3） Fungus cultured： yeast like cells were found in the culture at 37℃ or in tissues. The fungi outside the host cells were elongated, often curved, Sausage like and with clearcemral septate. When cultured at 25℃ ,the fungus was mycelia like and produced a characteristic red Pigment, diffusing into the medium. （4） CD4 cell count was reduced significantly, HIV-RNA was high. （5）Mortality was high. Conclusions Definite diagnosis of disseminated Penicillium marneffei requires culture of the pathogenic fungus from clinical specimens. No specific clinical manifestation for Penicillum marneffei infection was found and Amphotericin B are effective in treating penicillosis marmeffei.

关 键 词：获得性免疫缺陷综合征 马尔尼菲青霉菌 马尔尼菲青霉菌病 

分 类 号：R512.91[医药卫生—内科学] R714.46[医药卫生—临床医学]