骨髓检查在艾滋病合并播散性马尔尼菲青霉菌感染早期诊断中的应用

bone marrow examination in early diagnosis of aids complicated with disseminated penicillium marneffei infection

目的 探讨骨髓检查在艾滋病合并播散性马尔尼菲青霉菌感染早期诊断中的价值.方法 对73例临床疑似播散性马尔尼菲青霉菌感染的艾滋病患者进行外周血及骨髓涂片检查,并进行外周血和骨髓真菌双相培养.结果 73例患者中有44例经外周血和骨髓真菌双相培养确诊为马尔尼菲青霉菌感染,其骨髓象的共同特征为:骨髓增生活跃或明显活跃;多数粒细胞有胞浆颗粒增粗、增多及空泡等改变,细胞核左移;组织细胞增多、胞体增大;浆细胞比例增高.其中12例患者在骨髓涂片中发现组织细胞胞质内吞噬成群桑葚样马尔尼菲青霉菌病原体,或单个吞噬,或病原体散在游离于细胞外;个别病例以粒系细胞增生为主,于中性粒细胞及单核细胞内吞噬单个或多个病原体,并在4例患者外周血涂片中发现中性粒细胞及单核细胞内吞噬单个或多个马尔尼菲青霉病原体.结论 骨髓检查在艾滋病合并播散性马尔尼菲青霉菌感染的早期诊断中有重要价值,比常规真菌双相培养法可提早7～10 d确诊,为抗真菌治疗赢得宝贵时机,可有效降低患者的病死率. abstract： objective to evaluate bone marrow smear examination in early diagnosis of aids complicated with disseminated penicillium marneffei infection. methods seventy-three clinically suspected aids patients complicated with disseminated peniciuium marneffei infection were included in the study. peripheral blood and bone marrow smear examinations, and the fungal thermally dimorphic culture were performed in all cases. results peniciuium marneffei infection was identified in 44 patients by peripheral blood and bone marrow fungal thermally dimorphic culture. the features of the bone marrow smear were as follows : they were all hyperplastic or significantly hyperplastic; there were thickened and increased granules, vacuolization and band-formed in most granulocytes; there were increased and augmented histiocytes, and increased plasma cells. in 12 samples of bone marrow smear, there were phagncytized mulberry-like penicillium marneffei organisms in the cytoplasm of the histiocytes or the organisms found extracellularly. one sample demonstrated the increased granulocytes and the phagocytized organisms in the neutrophils and monocytes. in 4 samples of peripheral blood smear, there were phagocytized penicillium marneffe organisms in the neutrophils and monocytes. conclusion bone marrow smear examination is of value in early diagnosis of aids complicated with disseminated penicillium marneffei infection, which is 7 to 10 days earlier than routine fungal thermally dimorphic culture.