马尼菲青霉病11例分析  

Analysis of 11 cases of penicilliosis marneffei

作　　者：周凤丽[1,2] 毕筱刚[1,2] 冯定云[1,2] 张天托[1,2] 

机构地区：[1]中山大学附属第三医院呼吸内科 [2]中山大学呼吸病研究所,广州510630

出　　处：《中国感染与化疗杂志》2012年第6期459-462,共4页Chinese Journal of Infection and Chemotherapy

摘　　要：目的回顾性分析11例马尼菲青霉病(PSM)的临床特征,为减少误诊、早期诊断和及时治疗提供依据。方法收集中山医科大学附属第三医院2003年1月至2012年3月收治的11例PSM患者,对其临床资料进行回顾性分析。结果①PSM患者临床症状出现的频率依次为咳嗽和咳痰、发热、消瘦、淋巴结肿大、肝脾肿大、贫血和咯血等;所患基础疾病依次为艾滋病、器官移植术后、风湿免疫性疾病和血液系统恶性肿瘤等,除艾滋病外,其他疾病患者既往都有使用免疫抑制剂史。②6例(54.5%)患者有外周血白细胞数升高,5例(45.5%)血红蛋白减低;影像学主要表现为肺部结节状或团块状影7例(63.6%),表现为播散性炎性病变3例(27.3%)和间质性病变1例(9.0%)。③病原菌培养阳性的临床标本依次为痰液4例(36.4%),血液3例(27.3%),经皮肺穿刺活检标本2例(18.3%),骨髓1例(9.0%),皮损分泌物1例(9.0%)。结论 PSM临床并发于免疫缺陷患者和使用免疫抑制剂患者,临床表现以发热和呼吸道症状为主,影像学表现不典型,易误诊,尽早进行临床各种标本的病原菌培养是早期诊断的关键,治疗首选两性霉素B,疗程需2个月以上。Objective To retrospectively review and analyze 11 cases of penicilliosis marneffei （PSM） in term s of the clinical features in order toreduce misdiagnosis, improve early diagnosis and treatment. Methods The 11 PSM patients were treated in the Third Affiliated Hospital of Sun Yat sen University between January 2003 and March 2012. Their clinical data were retro spectively reviewed and analyzed. Results The major clinical symptoms of PSM patients were cough and sputum, fever, emacia tion, lymph node enlargement, hepatosplenomegaly and anemia, and hemoptysis, in terms of frequency. The underlying disea ses were H1V/AIDS, organ transplantation, rheumatic immune disorders and hematological malignancies. All the patients ex- cept those with HIV/AIDS had history of prior immunosuppressive therapy. Increased peripheral WBC was seen in 6 （54.5%） patients, reduced hemoglobin in 5 （45.5%）patients. Chest CT showed nodular orlumpishlesion in 7 （63.6%） patients, disseminated inflammatory lesions in 3 （27.3%） patients, and interstitial lesion in 1 （9.0%） patient. The culture was positive for Penicillium marneffei in sputum （4, 36.4%）, blood （3, 27.3%）, specimens of percutaneous lung biopsy （2, 18.3%）, bone marrow and secretion of skin lesion （1 each, 9.0 %）. Conelusions PSM is usually observed in the immunocompromised patients and the patients who is receiving immunosuppressive agent. The main clinical manifestations are fever and respiratory symp toms. The imaging findings are atypical, which may lead to misdiagnosis. Culture of Penicillium marneffei with various clinical specimens available as soon as possible is the key to early diagnosis. Amphotericin B is the first choice for thetreatment of PSM. Amphotericin B treatment should last more than two months.

关 键 词：马尼菲青霉病 临床特点 诊断 治疗 

分 类 号：R512.91[医药卫生—内科学]