艾滋病合并播散性马尔尼菲青霉菌感染一例  

Disseminated Penicillium marneffei infection associated with AIDS, report of a case

作　　者：廖小梅[1] 孟文彤[1] 向兵[1] 邓承祺[1] 冉玉平[2] 熊琳[2] 李志瑜[2] 庄杰[2] 陈卉娇 李甘地[3] 刘卫平[3] 康梅[4] 彭雪梅[5] 

机构地区：[1]华西医科大学附属第一医院血液科,成都610041 [2]华西医科大学附属第一医院皮肤性病科,成都610041 [3]华西医科大学附属第一医院病理科,成都610041 [4]华西医科大学附属第一医院检验科,成都610041 [5]华西医科大学附属第一医院法医学院电镜室,成都610041

出　　处：《中华医学杂志》2002年第5期325-329,共5页National Medical Journal of China

摘　　要：目的　探讨艾滋病合并播散性马尔尼菲青霉菌感染患者临床及实验室特征。方法　(1 )用酶免疫法和免疫印迹法检测患者血清的HIV抗体 ;(2 )骨髓涂片及活检观察真菌形态 ;(3)取皮损做真菌培养、鉴定及动物实验 ,在 2 5℃和 37℃培养中从大体、显微镜及扫描电镜观察真菌特征。结果　播散性马尔尼菲青霉菌病常见临床表现为发热、体重减轻、贫血、丘疹性皮肤损害及肝、脾、淋巴结肿大。在 37℃培养或组织中马尔尼菲青霉菌呈酵母型 ;在组织细胞外真菌较长 ,常弯曲 ,有横隔 ,似腊肠状 ;在 2 5℃培养中呈菌丝型 ,并产生红色色素扩散入培养基中。结论　播散性马尔尼菲青霉菌病是东南亚地区及中国南部艾滋病患者最重要的机会性感染之一 ;由于临床表现无特征性 ,常易误诊。确诊需作真菌培养。此真菌特征为温度双相性 ;可产生红色色素 ;可见有横隔的腊肠状细胞。Objective To explore the clinical and laboratory features of disseminated Penicillium marneffei infection in patients with AIDS. Methods The HIV antibody in serum was assayed by both enzyme immunoassay (EIA) and Western immunoblot (WIB) methods. Morphology of the pathogenic fungus in smear and biopsy specimens of bone marrow was observed. The fungus was isolated from the patient's skin lesion and inoculated into the abdominal cavities of 2 rats and 2 mice. Twenty days later the rats and mice were killed and their viscera were taken out. Blood from the organs were cultured in Sabourand glucose agar at 25℃ and 37℃. The colonies were observed. The morphology of the fungus was observed by microscopy and scanning electron microscopy. Results The most common clinical manifestations of Penicilium marneffei infection were fever, weight loss, anemia, papular skin lesion, hepatosplenomegaly, and lymphadenectasis. 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 clear central septi. When cultured at 25℃, the fungus was mycelia like and produced a characteristic red pigment, diffusing into the medium. Conclusion Disseminated Penicilliosis marneffei is one of the most important opportunistic infections in patients with AIDS in Southeast Asia and the southern part of China. Since there is no specific clinical manifestation for Penicillium marneffei infection, it is often misdiagnosed. Definite diagnosis requires culture of the pathogenic fungus from clinical specimens. The fungus is thermally dimorphic, produces red pigment, and is sausage-form with clear central septum outside the host cell. Amphotericin B and itraconazole are effective in treating Penicilliosis marneffei.

关 键 词：获得性免疫缺陷综合征 青霉属 艾滋病 合并症 播散性马尔尼菲青霉菌感染 真菌感染性疾病 

分 类 号：R512.91[医药卫生—内科学] R519.8[医药卫生—临床医学]