艾滋病合并马红球菌感染1例并文献复习  

Disseminated Rhodococcus equi infection in a patient in advanced HIV and literature review

作　　者：覃江龙 吴念宁[1] 梁纲[2] 卢祥婵[1] 卢亦波[1] QIN Jianglong;WU Nianning;LIANG Gang;LU Xiangchan;LU Yibo(The Fourth People＇s Hospital of Nanning,Nanning,Guangxi 530023,China)

机构地区：[1]南宁市第四人民医院,广西南宁530023 [2]广西医科大学病理生理学教研室,广西南宁530021

出　　处：《中国热带医学》2018年第9期968-972,共5页China Tropical Medicine

基　　金：南宁市科学研究与技术开发计划项目(No.201109047C)

摘　　要：马红球菌是人类感染性疾病谱中一个较为罕见的病原体,但在获得性免疫缺陷综合症患者中已成为一种机会性致病性病原体。通常表现为亚急性肺炎,多数为空洞性肺炎,有时甚至是细菌性肺炎。虽然在自然界分布广,但是从临床和微生物学的方面来诊断马红球菌感染仍然具有挑战性,目前还没有建立标准的治疗方案。此次报道分析一例艾滋病合并马红球菌性肺炎及败血症患者的详细情况。患者为29岁男性,以咳嗽、咳痰、发热为主要临床表现,肺脏组织镜下见灶状坏死,中性粒细胞和浆细胞浸润,无明显的干酪样坏死。痰液、骨髓、肺脓肿均培养出马红球菌。我们描述马红球菌的临床特点,强调早期诊断及联合抗生素治疗的重要性,为持续进行抗逆转录病毒治疗做好准备。Rhodococcus equi is an unusual cause of infection in human, but has emerged as an opportunistic pathogenamong acquired immunodeficiency syndrome patients. The disease is usually presented as subacute pneumonia that is mostlycavitary and sometimes bacteremic. Although the spectrum of disease is broad, Rhodococcus equi infections remainschallenging, both from clinical and microbiological view,and no standard treatment has been established. In this report, wepresent a detailed case of acquired immunodeficiency syndrome combined with Rhodococcus equi. A 29-year-old male whorepresented with cough, expectoration and fever. Lung histopathological examination showed focal necrosis, infiltration byneutrophils, plasma cells and macrophages, no caseous necrosis. Blood culture and culture of sputum,empyema and bonemarrow were positive for Rhodococcus equi. We describe the clinical features of Rhodococcus equi infections, highlight theimportance of an early diagnosis and combined parenteral antibiotics, which prepares for continued antiretroviral therapy.

关 键 词：艾滋病 马红球菌 机会性感染 结核分枝杆菌 马尔尼菲青霉菌 

分 类 号：R512.91[医药卫生—内科学]