马尔尼菲篮状菌病18例患者临床特征和微生物学检测分析  

Clinical characteristics and microbiological tests analysis of 18 patients with Talaromyces marneffei infection

作　　者：邹盛华 方美兰 林珍丽 陈新朝 黄明翔 官红莲 王新航 ZOU Sheng-hua;FANG Mei-lan;LIN Zhen-li;CHEN Xin-chao;HUANG Ming-xiang;GUAN Hong-lian;WANG Xin-hang(Fuzhou Pulmonary Hospital of Fujian Province,Fuzhou,Fujian 350008,China)

机构地区：[1]福州肺科医院,福建福州350008

出　　处：《中国热带医学》2023年第2期139-145,共7页China Tropical Medicine

基　　金：福建省临床重点专科建设项目(No.闽卫医政函[2018]145号)。

摘　　要：目的探讨马尔尼菲篮状菌(Talaromyces marneffei,T.marneffei)感染引发马尔尼菲篮状菌病(Talaromycosis marneffei,TSM)的临床特征和早期诊断方法,以减少TSM患者病死率。方法收集福州肺科医院2017年1月—2021年12月确诊18例TSM患者的临床特征和微生物学检测资料,并进行描述性分析。结果18例患者均通过传统培养及MALDI-TOF MS方法确诊为T.marneffei感染,主要感染部位为肺和淋巴结,患者伴有咳嗽、咳痰和发热等临床表现。影像学常见斑片影、纵隔淋巴结影和结节影等。微生物检测显示,涂片与培养比较,培养阳性率较高,差异有统计学意义(χ^(2)=13.74,P<0.05)。血液、支气管灌洗液、痰液培养阳性率分别为60.0%(9/15)、26.7%(4/15)和5.6%(1/18),脓液、骨髓、胸水及脑脊液各1例培养阳性;临床标本直接涂片痰和脓液各1例阳性,其余均阴性。菌落特征显示,25℃培养菌落形态为菌丝相,产生红色色素,镜下可见单轮生或双轮生帚状枝;35℃为初期呈酵母相,5~6 d后转为菌丝相;37℃呈酵母相,镜下可见酵母样细胞。18例TSM患者使用抗真菌药物后均好转。与非HIV合并TSM患者相比,HIV合并TSM患者常见白细胞减少和贫血,差异显著有统计学意义(P<0.05)。结论T.marneffei感染分为局限型和播散型,常入侵肺部或皮肤、淋巴结等部位。患者主要表现为发热、咳嗽、咳痰等不典型症状。T.marneffei感染确诊多依靠真菌培养,MALDI-TOF MS方法的应用可缩短TSM确诊时间。临床特征结合微生物学分析为TSM患者的早期诊断提供了客观依据,及时使用抗真菌治疗可以改善患者的预后。Objective To investigate the clinical characteristics and early diagnostic methods of patients with Talaromyces marneffei infection,so as to reduce the mortality of patients.MethodsThe clinical characteristics and microbiological analysis data including fungal culture,smear examination and mass spectrometry were collected from 18patients with Talaromyces marneffei infection in the Department of Respiratory Medicine,Department of Tuberculosis,and Department of Critical Respiratory Medicine in Fuzhou Pulmonary Hospital from January 2017 to December 2021,and descriptive analysis was conducted.ResultsAll the 18 patients were confirmed to be infected with Talaromyces marneffei by conventional culture and matrix-assisted laser desorption/ionization-time of flight(MALDI-TOF)mass spectrometry(MS).The main infection sites of 18 patients with Talaromyces marneffei infection were lungs and lymph nodes,and the patients were accompanied by clinical manifestations such as cough,sputum and fever.The imaging features such as patchy shadows,mediastinal lymph node shadows and nodular shadows were common.Microbiological testing showed a statistically significant difference between smear and culture with a higher positive culture rate(χ^(2)=13.74,P<0.05).The positive rate of blood culture in microbiological test was 60.0%(9/15),the positive rate of bronchial lavage fluid culture was 26.7%(4/15),the positive rate of sputum culture was 5.6%(1/18),one case each of pus,bone marrow,pleural fluid and cerebrospinal fluid was positive for culture and the other cases were negative,one case of sputum and one case of pus were positive for smear and the rest were negative.Colony characteristics showed that the colony morphology was mycelial phase at 25℃,producing red pigment,and the branching pattern of the penicillus was seen microscopically as monoverticillate or biverticillate;At 35℃,the yeast phase appeared at the initial stage,and then the mycelium phase changed after 5-6 days;the yeast phase was observed at 37℃,and yeast-like cells

关 键 词：马尔尼菲篮状菌 双相型真菌 人类免疫缺陷病毒 

分 类 号：R12[医药卫生—环境卫生学]