艾滋病患者马红球菌肺部感染的临床特点与治疗观察  

Rhodococcus equi pneumonia among patients with AIDS clinical features and treatment

作　　者：蒙志好 李勇 黄葵 李太生[2] 卢洪洲[3] 

机构地区：[1]广西壮族自治区龙潭医院内七科,柳州545005 [2]中国医学科学院北京协和医院 [3]复旦大学附属公共卫生临床中心

出　　处：《中华医学杂志》2010年第9期593-596,共4页National Medical Journal of China

基　　金：国家“十一五”科技攻关课题（2008ZX10001-008）

摘　　要：目的提高对艾滋病患者马红球菌肺部感染的临床、胸部影像学和微生物学的认识。方法2007年5月至2009年11月，广西龙潭医院收治艾滋病患者1908例，其中合并马红球菌感染15例（0．79％），均为男性，年龄26—71岁，平均（35±13）岁，对其临床表现、胸部X线、CT和微生物学资料进行分析。结果14例表现为肺炎或肺脓肿。患者主要表现为发热（100％）、咳嗽咳痰（93．3％）、胸痛（26．7％）等，体检可有肺实变的体征，血红蛋白〈60g／L5例，CD4^＋T淋巴细胞（1～51）×10^6／L，平均（20±16）×10^6／L，胸部X线或CT呈团块状阴影、空洞或肺不张，痰、血、经皮肺穿刺物、纤维支气管镜肺泡灌洗液等标本培养有马红球菌生长，经使用敏感抗生素后，肺部病灶缓慢吸收。15例均进行了抗反转录病毒治疗，随访33d至2年余，死亡4例，存活的病例免疫重建良好。结论马红球菌感染是人类罕见的疾病，艾滋病患者偶有发病，需长疗程使用敏感抗生素才能奏效。Objective To summarize the characteristics of clinical manifestation, chest radiology and microbiology of Rhodococcus equi pneumonia among patients with AIDS. Methods Total 1908 AIDS patients who have therapy in Longtan hospital of Guang Xi province since May 2007 to Nov 2009, 15 patients （0. 79% ） who were co-infected with Rhodococcus equi, and average age was 35 ± 13 years, we retrospectively reviewed clinical manifestations, chest radiology and microbiology of nine HIV-infected patients complicated with Rhodococcus equi pneumonia. Results 14 patients presented with pneumonia or lung abscess, the clinical manifestations included fever （ 100% ）, cough and expectoration （ 93.3% ）, bellyache（26. 7% ）, etc. And 5 patients Hb lower than 60 g/L, CD4^＋ T cell count was between （ 1 - 51 ） × 10^6/L, average was （20 ± 16） × 10^6/L, Patients presented with consolidation of lung. X-ray, or CT of lung showed large patchy consolidation image, inanition, atelectasis in the lung. Rbodococcus equi could be cultured from sputum, blood, tissue obtained through lung puncture, broncho-alveolar lavage fluid, etc. Though susceptible antibiotics were used, the focus in the lung was absorbed slowly, All of 15 patients begin with HAART, after 33day to 2years follow up 4 patients die and alive patients have perfect immune-rebuih. Conclusions Rhodococcus equi infection, an unusual disease, can be seen in AIDS patients and can be cured only with long-term effective antibiotic.

关 键 词：HIV-1 艾滋病 红球菌 马 

分 类 号：R512.91[医药卫生—内科学] R519[医药卫生—临床医学]