肾移植术后马尔尼菲篮状菌肺部感染1例  

Penicillium marneffei infection after renal transplantation:one case report

作　　者：蔡泽宇 鄢业鸿[1] 肖琦[1] 张行健 周琛 韩佳良 陈琼 Cai Zeyu;Yan Yehong;Xiao Qi;Zhang Xingjian;Zhou Chen;Han Jialiang;Chen Qiong(Department of Organ Transplantation,First Affiliated Hospital,Nanchang University,Nanchang 330006,China)

机构地区：[1]南昌大学第一附属医院器官移植科,南昌330006

出　　处：《中华器官移植杂志》2023年第7期428-432,共5页Chinese Journal of Organ Transplantation

摘　　要：通过回顾1例肾移植术后肺部感染马尔尼菲篮状菌受者的临床病例资料及诊疗过程,探讨肾移植术后马尔尼菲篮状菌病(peniciliosis marneffei,PSM)的临床诊断及治疗。本例既往存在肺结核病史,因尿毒症行肾移植手术,术后恢复良好出院,7个月时出现反复咳嗽。纤维支气管镜及肺部CT检查均提示肺结核可能,最终经肺泡灌洗液二代测序检测及病原菌培养确诊PSM。经调整免疫抑制药物并使用伏立康唑规律抗真菌治疗,呼吸道症状改善,肺部CT检查示病灶吸收。提示马尔尼菲篮状菌肺部感染可能出现与肺结核类似的纤支镜表现及影像学征象,早期的病原学培养及二代基因测序有助于诊断,伏立康唑等抗真菌药物对于该病治疗有效。Clinical data were retrospectively reviewed for one case of penicillium marneffei infection after renal transplantation(RT)to explore a proper management of peniciliosis marneffei(PSM)transplantation.This case had a history of pulmonary tuberculosis and underwent RT due to uremia.After discharging,postoperative recovery was excellent.Recurrent cough occurred at Month 7 post-operation.Fiberoptic bronchoscopy and pulmonary CT indicated a possibility of pulmonary tuberculosis.However,a definite diagnosis of PSM was confirmed by next generation sequencing(NGS)and pathogenic bacteria culture of alveolar lavage fluid.After adjusting immunosuppressive agents and regular antifungal treatment with voriconazole,respiratory symptoms improved and pulmonary CT hinted at a resorption of lesion.Features of pulmonary CT and bronchoscopic examination were nearly similar to those of tuberculosis.Thus early bacterium culture and NGS may aid an definite diagnosis.Voriconazole is an effective treatment of the disease.

关 键 词：肾移植 感染 马尔尼菲篮状菌 肺结核 

分 类 号：R699.2[医药卫生—泌尿科学] R563.1[医药卫生—外科学]