马尔尼菲青霉菌病的临床特点与实验室检测  

The clinical features and laboratory examination of Penicilliosis Marneffei

作　　者：高世华 池细俤 李国玉 吴文辉 GAO Shi-hua;CHI Xi-di;LI Guo yu(The Affiliated First Hospital of Nanping,Fujian Medical University,Nanping 353000,China)

机构地区：[1]福建医科大学附属南平第一医院检验科,福建南平353000

出　　处：《中国实验诊断学》2018年第11期1885-1887,共3页Chinese Journal of Laboratory Diagnosis

摘　　要：目的了解马尔尼菲青霉菌病(PSM)的临床特点,总结实验室检测的经验。方法回顾性分析2015.01-2017.11某院收治的13例PSM病例的临床特点;并对马尔尼菲青霉菌(PM)进行菌种鉴定和药敏试验。结果AIDS、肾移植后等免疫力低下的患者易患PSM;本地区PSM发病无季节性和旱雨季的特征。PSM患者血清CRP、SAA水平显著升高,均值分别为49.83mg/l、119.19mg/l;7例血清AST异常的患者中6例AST/ALT>1;5-氟胞嘧啶等5种抗真菌药物的MIC50和MIC90值较低。结论加强易感人群的管理以降低PSM发病率;CRP及SAA可以做为PM感染的敏感标志物;AST>1×ULN且AST/ALT>1可做为PSM患者肝脏病理变化的辅助指标;重视血液或骨髓涂片中PM的形态学检测、延长真菌培养观察时间可减少漏检;PM药敏试验时应平行进行菌落计数以提高药敏试验的重复性。Objective To understand clinical characteristics of Penicilliosis Marneffei（PSM）and to learn lessons in laboratory testing.Methods We retrospectively analyzed clinical features of 13 cases of PSM from January 2015 to November 2017 from hospital and performed strain identification and antifungal susceptibility test for Penicillium marneffei（PM）.Results Patients with low immunity such as patients after renal transplantation or AIDS patients are susceptible to PSM.There is no regular pattern of seasonality or dry-rainy seasonality for the onset of PSM.The value of CRP and SAA in the serum of PSM patients increased significantly,the mean value was 49.83 mg/l and 119.19 mg/l,respectively.AST/ALT ratio of 6 cases out of 7 patients with abnormal serum were〉1,and 5 antifungal agents such as 5-fluorine cytosine were low in MIC50 and MIC90 value.Conclusion The incidence of PSM can be reduced by strengthen the management of susceptible people;CRP and SAA can be a sensitive marker for PM infection.AST〉1×ULN and AST/ALT〉1 can be used as auxiliary indexes of liver pathological changes in patients with PSM;Paying attention to the morphological examination of PM in blood or bone marrow smear and prolonging the observation time of fungal culture can reduce rate of the missed detection;PM drug sensitivity test should be performed in parallel in order to improve the repeatability of the colony counting of antifungal susceptibility test.

关 键 词：马尔尼菲青霉菌 马尔尼菲青霉菌病 临床 菌型鉴定 药敏试验 

分 类 号：R379.9[医药卫生—病原生物学] R519.8[医药卫生—基础医学]