陕西省内脏利什曼病伴黑曲霉菌感染1例  

A case of visceral leishmaniasis with Aspergillus niger infection in Shaanxi Province

作　　者：邢佳 余艳丽 汪建军 许世娟 XING Jia;YU Yanli;WANG Jianjun;XU Shijuan(Shaanxi Nuclear Industry 215 Hospital,Xianyang 712000,Shaanxi,China)

机构地区：[1]陕西省核工业二一五医院,陕西咸阳712000

出　　处：《中国寄生虫学与寄生虫病杂志》2024年第6期820-822,826,共4页Chinese Journal of Parasitology and Parasitic Diseases

摘　　要：患者,女,55岁,因“发现血细胞异常9月余”于2024年4月17日入陕西省核工业二一五医院血液科。多次检查血常规见血细胞进行性减低,白细胞最低1.4×10^(9)/L,血红蛋白最低90 g/L,血小板最低90×10^(9)/L,间断给予“地榆升白片、粒细胞刺激因子”等升细胞治疗,白细胞难以维持正常。患者既往较长时间从事户外工作,自诉有蚊虫、白蛉叮咬史。入院后查体,体温37℃,血压73/43 mmHg (1 mmHg=0.133 kPa),精神欠佳,慢性病容,皮肤散在约黄豆大小皮痂及鳞屑分布。CT示肝稍大,巨脾,门脉增宽,脾大。骨髓穿刺,涂片可见巨核系成熟延迟,小细胞低色素性贫血,巨噬细胞内查见利什曼原虫利杜体;骨髓活检示吞噬有寄生虫或微生物的吞噬细胞。宏基因捕获法(MetaCAP)病原微生物检测示婴儿利什曼原虫序列数为371 554,黑曲霉菌序列数为86880。诊断为内脏利什曼病伴黑曲霉菌感染。给予葡萄糖酸锑钠(6 ml/d)联合避光泵入两性霉素B胆固醇硫酸酯复合物(50 mg/d)治疗,两周后症状好转,患者出院。1月后随访,复查血常规均恢复正常,余未见明显异常。A woman aged 55 years was admitted to Department of Hematology,Shaanxi Nuclear Industry 215 Hospital on April 17,2024 because of abnormal blood cell parameters for more than 9 months.Multiple routine blood tests showed progressive reductions of blood cells,with the lowest white blood cell count of 1.4×10^(9)/L,hemoglobin levels of 90 g/L,and platelet levels of 90×10^(9)/L.The patient was given intermittently cell-boosting treatments with Diyushengbai tablets and granulocyte colony stimulating factors,resulting in difficulty in maintaining white blood cell counts.The case had worked outdoors for a long period of time,and complained of mosquito and sandfly bites.Admission physical examinations showed a body temperature of 37℃,blood pressure of 73/43 mmHg(1 mmHg=0.133 kPa),poor mental health,facial appearance of chronic diseases and soybean-sized scabs and scales scattered on the skin.CT shows slightly enlarged liver,enlarged spleen,widened portal vein,and enlarged spleen.Bone marrow aspiration revealed delayed maturation of megakaryocytes,hypochromic anemia of small cells,and detection of Leishmania-Donovan body in macrophages.Bone marrow biopsy showed phagocytosis of phagocytic cells containing parasites or microorganisms.Metagenomics capture(MetaCAP)pathogen detection showed that the sequence number of L.infantis was 371554,and the sequence number of Aspergillus niger was 86880.The diagnosis was visceral leishmaniasis with A.niger infection.Following administer sodium antimony gluconate(6 ml/d)in combination with light shielded pump administration of amphotericin B cholesterol sulfate complex(50 mg/d)for treatment for two weeks,the case had improved symptoms and was discharged from hospital.One-month follow-up showed that routine blood tests returned to normal,and no other remarkable abnormalities.

关 键 词：内脏利什曼病 宏基因组第二代测序 病原宏捕获技术 感染性疾病 

分 类 号：R531.6[医药卫生—内科学]