14例成人非HIV感染播散性马尔尼菲篮状菌并溶骨性破坏的临床回顾性分析  

A clinical retrospective analysis of disseminated Talaromyces marneffei and osteolytic destruction in 14 non-HIV infected adults

作　　者：黄春兰[1] 侯蓓蕾[1] 罗柳春 贺月园 HUANG Chunlan;HOU Beilei;LUO Liuchun;HE Yueyuan(Medical Laboratory Department,Liuzhou People's Hospital,Liuzhou Key Laboratory of Precision Medicine for Viral Diseases Guangxi Health Commission Key Laboratory of Clinical Biotechnology(Liuzhou People's Hospital)Liuzhou,Guangxi 545001,China)

机构地区：[1]柳州市人民医院检验科,柳州市病毒性疾病精准医学重点实验室,广西壮族自治区卫生健康委员会,广西临床疾病生物技术研究重点实验室(柳州市人民医院),广西柳州545001

出　　处：《中国热带医学》2024年第5期618-623,共6页China Tropical Medicine

基　　金：柳州市科技局课题(No.2022CAC0215)。

摘　　要：目的回顾性分析马尔尼菲篮状菌病(Talaromycosis,TSM)并发溶骨性破坏患者的临床特征,提高对非HIV感染TSM的诊断和治疗。方法收集柳州市人民医院2019年1月—2023年10月近5年间非HIV感染成人确诊为TSM并发溶骨性破坏患者的临床特征及各项检查数据。结果14例患者均无人类免疫缺陷病毒感染、无任何基础疾病,患者均有发热、贫血、消瘦等全身表现,骨痛7例,首发症状以颈部肿物、皮肤出现溃疡、流脓为主,实验室检查以白细胞、C反应蛋白、红细胞沉降率升高为主,CD4^(+)淋巴细胞数(157~1477)个/μL,CD8^(+)淋巴细胞数(112~1779)个/μL,CD4^(+)/CD8^(+)(0.651~3.797);病原学检测有9例颈部、胸部、脸部、关节脓性或溃疡分泌物培养阳性,1例纵膈淋巴结宏基因测序阳性,4例痰和肺泡灌洗液培养阳性,1例血培养阳性。影像表现为溶骨性破坏,可侵犯全身任何部位骨骼,9例治疗好转,2例死亡,3例未见好转,6例误诊为肺癌和转移瘤,7例抗真菌治疗后合并非结核分枝杆菌感染,4例马尔尼菲篮状菌和结核分枝杆菌同时感染。结论TSM并发溶骨性破坏好发于非HIV感染者,突出的表现有剧烈骨或关节疼痛。早期诊断困难,易合并非结核分枝杆菌或结核分枝杆菌感染,临床上易误诊为癌症和肿瘤。Objective To retrospectively analyze the clinical characteristics of patients with Talaromyces marneffei infection(TSM)complicated by osteolytic lesions in non-HIV infected individuals,aiming to improve the diagnosis and treatment of TSM in non-HIV patients.Methods Clinical characteristics and laboratory data,of non-HIV adults diagnosed with TSM complicated by osteolytic destruction were collected from the People′s Hospital of Liuzhou City from January 2019 to October 2023,covering nearly five years.Results All 14 patients were healthy hosts without HIV infection or any underlying diseases.All patients had systemic manifestations such as fever,anemia,and weight loss,while 7 patients experienced bone pain.The initial symptoms mainly included neck mass,ulceration,and purulent discharge from the skin.Laboratory tests showed elevated white blood cell counts,C-reactive protein,and erythrocyte sedimentation rate.The CD4^(+)lymphocyte count ranged from 157 to 1477 cells/μL,and CD8^(+)lymphocyte counts from 112 to 1779 cells/μL,with CD4^(+)/CD8^(+)ratios from 0.651 to 3.797.Pathogenic evidence was obtained from positive cultures of purulent or ulcerative secretions from the neck,chest,face,and joints in 9 cases,positive metagenome sequencing of mediastinal lymph nodes in 1 case,positive cultures of sputum and bronchoalveolar lavage fluid in 4 cases,and positive blood cultures in 1 case.Imaging findings showed osteolytic destruction involving any part of the skeleton.Nine patients improved with treatment,2 died,3 showed no improvement,and 6 cases were misdiagnosed as lung cancer or metastatic tumors.After antifungal treatment,7 patients developed non-tuberculous mycobacterial infection,and 4 cases were co-infected with TSM and Mycobacterium tuberculosis.Conclusions TSM complicated by osteolytic destruction is more common in non-HIV infected,with prominent manifestations of severe bone or joint pain.Early diagnosis is difficult,and it is prone to be complicated by non-tuberculous mycobacterial or Mycobacterium tubercul

关 键 词：马尔尼菲篮状菌 溶骨性破坏 成人非HIV感染 播散性真菌感染 

分 类 号：R519[医药卫生—内科学]