艾滋病合并耶氏肺孢子菌肺炎及马尔尼菲篮状菌、新型隐球菌播散性感染1例  

A case of AIDS complicated with Pneumocystis jirovecii pneumonia and disseminated infection of Talaromyces marneffei and Cryptococcus neoformans

作　　者：罗柳春 黄春兰[1] 覃仁利 周婷婷 LUO Liu-chun;HUANG Chun-lan;QIN Ren-li;ZHOU Ting-ting(Liuzhou People's Hospital,Liuzhou,Guangxi 545001,China)

机构地区：[1]柳州市人民医院,广西柳州545001

出　　处：《中国热带医学》2022年第11期1106-1108,共3页China Tropical Medicine

基　　金：广西壮族自治区卫生健康委员会自筹经费科研课题(No.Z20210060)。

摘　　要：艾滋病同时合并耶氏肺孢子菌肺炎(Pneumocystis jirovecii pneumonia,PJP)、马尔尼菲篮状菌和新型隐球菌播散性感染少见报道,本文对1例合并多种真菌感染的艾滋病患者的诊疗进行分析总结,以供参考。患者男,79岁,以“大便习惯改变20余天”入院,入院检查:白细胞计数4.57×10^(9)/L,中性粒细胞百分数81.8%,CD4~+淋巴细胞绝对计数6个/μL,CD4/CD8比值0.17,经疾控中心确认HIV抗体阳性。脑脊液和肺泡灌洗液新型隐球菌荚膜抗原测定阳性,支气管肺泡灌洗液六胺银染色找到耶氏肺孢子菌,脑脊液培养检出新型隐球菌,血培养同时检出新型隐球菌和马尔尼菲篮状菌。CT示双肺支气管血管束粗多,两肺见斑片状、条索状高密度影,边缘模糊;左肺上叶尖后段见结节状、条索状高密度影,边缘清楚;考虑两肺感染,左肺上叶继发型肺结核。患者入院后因反复发热,先后使用多种抗细菌、真菌药物治疗,效果不佳。患者发热症状等均得不到明显改善,病情持续加重,最终死亡。艾滋病合并细菌、真菌感染,尤其同时合并PJP感染者,病情严重且发展迅速预后差,临床应引起重视。AIDS combined with Pneumocystis jirovecii pneumonia (PJP) and disseminated infections of Talaromyces marneffei and Cryptococcus neoformans are rare.This paper summarizes and analyzes the diagnosis and treatment of an AIDS patient with multiple fungal infections for reference.A 79-year-old male patient was admitted to the hospital with"stool habit change for more than 20 days".The white blood cell count was 4.57×10^(9)/L,the percentage of neutrophils was 81.8%,the absolute count of CD4lymphocytes was 6/μL,and the CD4/CD8 ratio was 0.17.HIV antibody positive was confirmed by CDC.The cerebrospinal fluid and alveolar lavage fluid were positive for Cryptococcus neoformans capsular antigen,and Pneumocystis jirovecii was found by the bronchoalveolar lavage fluid stained with hexamine silver.The cerebrospinal fluid culture was positive for Cryptococcus neoformans,and the blood culture was positive for Cryptococcus neoformans and Talaromyces marneffei.CT showed that bronchovascular bundles in both lungs were more thick,patchy and cable-like high-density shadows were seen in both lungs,and the edges were blurred.Nodular and cable-like high-density shadows were seen in the posterior apical segment of the left upper lobe,with clear margins.Infection of both lungs was considered,and secondary pulmonary tuberculosis occurred in the left upper lobe.After admission,the patient was treated with various anti-bacterial and fungal drugs due to recurrent fever,but the effect was not effective.The fever symptoms of the patient could not be significantly improved,and his condition continued to worsen,and he eventually died.The patient with AIDS complicated with bacterial and fungal infection,especially PJP infection in serious condifiton and has a poor prognosis for rapid development,so clinical attention should be paid to.

关 键 词：艾滋病 耶氏肺孢子菌 马尔尼菲蓝状菌 新型隐球菌 

分 类 号：R512.91[医药卫生—内科学]