艾滋病合并马尔尼菲青霉菌感染11例临床分析并文献复习  

Clinical analysis of 11 AIDS patients with Penicillium marneffei infection and literature review

作　　者：刘昕超[1] 索小英 汪雯[3] 郭娜[3] 牟丹蕾[3] 张彤[3] 吴昊[3] 黄晓婕[3] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院感染内科,100730 [2]东营市人民医院感染内科 [3]首都医科大学附属北京佑安医院感染中心

出　　处：《北京医学》2015年第9期820-823,I0001,共5页Beijing Medical Journal

基　　金：国家自然科学基金(81201294);国家"十二五"科技重大专项(2012ZX10001-003;2012ZX10001-006);北京市自然科学基金(7132077);北京市科技计划课题(D141100000314002;D141100000314005);北京市艾滋病重点实验室(BZ0089)

摘　　要：目的探讨AIDS合并马尔尼菲青霉菌感染患者的临床特征。方法收集北京佑安医院2009年1月至2015年5月收治的11例AIDS合并马尔尼菲青霉菌感染患者的病历资料，回顾性分析患者的临床特征、微生物学特点以及疾病转归。结果临床表现为发热10例、体重下降8例、皮疹7例、咳嗽6例、淋巴结肿大7例、肝脾肿大7例。11例患者的CD4＋T淋巴细胞计数均〈50个／μl。马尔尼菲青霉菌血培养阳性6例，皮肤活检或皮损渗液培养阳性3例，骨髓培养阳性3例，肠黏膜活检培养阳性1例，腹水培养阳性1例，痰培养阳性1例，培养阳性时间2～7d。两性霉素B序贯伊曲康唑治疗8例，伊曲康唑单药治疗2例，1例未抗真菌治疗。最终治愈9例，死亡2例。结论AIDS合并马尔尼菲青霉菌感染以发热、消瘦、皮疹、咳嗽、肝脾淋巴结肿大为主要表现，好发于既往有该菌流行地区旅居史的AIDS晚期患者，皮肤活检及骨髓培养阳性率高达100％。两性霉素B是治疗AIDS合并马尔尼菲青霉菌感染的首选药物，具有较好疗效，但如延误治疗预后较差。Objective To summarize the clinical characteristics of Penicillium marneffei infection in AIDS pa- tients. Methods Clinical, laboratory and microbiological features, together with therapeutic responses were retrospective- ly analyzed in 11 cases of AIDS associated Penicillium marneffei infection in Beijing You＇an Hospital from Jan 2009 to May 2015. Results The common clinical symptoms included fever （10 cases）, weight loss （8 cases）, characteristic skin le- sions （7 cases）, cough （6 cases）, lymphadenopathy （7 cases） and hepatosplenomegaly （7 cases）. The CD4＋ T lymphocytes counts of all the patients were less than 50 cells/μl. Blood culture（6/10）, skin biopsy or effusion culture（3/3）, bone marrow culture（3/3）, intestine biopsy culture（1/1）, ascites culture（1/2） and sputum culture（1/9） were positive for Penicillium rnarneffei. It took 2-7 days for the organism to grow. Eight cases were treated with amphotericin B followed by itracon- azole while 2 cases with itraconazole only, and 1 case received no antifungal therapy. Nine cases healed and 2 cases de- ceased. Conclusion Patients with AIDS associated Penicillium marneffei infection commonly present with fever, weight loss, skin lesions, cough, lymphadenopathy and hepatosplenomegaly. The infection is commonly seen in the late stage of AIDS patients who have been to epidemic areas. Culture of skin lesions and bone marrow are 100% positive. Amphoteri- cin B can be used as the first choice treatment with good outcome. Delayed treatment may lead to poor prognosis.

关 键 词：艾滋病 马尔尼菲青霉菌 

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