艾滋病合并马尔尼菲青霉病的临床分析

Clinical Analysis of AIDS-associated Penicilliosis Marneffei

【目的】探讨艾滋病合并马尔尼菲青霉病的临床及实验室特征。【方法】回顾分析2002年11月至2005年12月本院收治明确诊断为艾滋病合并马尔尼菲青霉病的53例临床及实验室资料。【结果】艾滋病合并马尔尼菲青霉病以发热、消瘦、咳嗽、皮疹、贫血等为主要临床特点,皮损主要表现为坏死性丘疹、脐凹状丘疹、溃疡、结节、血痂;外周血CD4+细胞显著减少;在沙氏琼脂培养基中马尔尼菲青霉呈酵母相(37℃)或菌丝相(25℃);药敏结果显示伊曲康唑、酮康唑对马尔尼菲青霉的MIC值最低,两性霉素B、5-氟胞嘧啶次之,氟康唑最高;病理组织六胺银染色见圆形、椭圆形或腊肠样病原体,部分有横隔。【结论】艾滋病合并马尔尼菲青霉病临床表现复杂,主要发生于CD4+计数少于50细胞∕μL的患者,真菌培养鉴定结合组织病理检查是确诊的关键,治疗上建议使用伊曲康唑、两性霉素B。

[Objective] To explore the clinical and laboratory features of AIDS-associated Penicilliosis marneffei. [ Methods] To review and analyze the clinical features and laboratory findings of fifty-three cases of AIDS-associated Penicilliosis marneffei hospitalized from November 2002 to December 2005. [Results] The main clinical features of AIDS-associated Penicilliosis marneffei were fever, weight loss, cough, skin rashes, and anemia. Main lesions include necrotic popules, umbilicate popules, ulcers, nodules, and blood crust. The amount of CD4^＋ lymphocyte in peripheral blood was clearly decreased. In Sabouraud＇ s cultured , the fungus were mycelia-like （25℃） or Yeast-like （37℃）. The result of drug sensitivity： the MIC of itraconazole and ketoconazole are lowest, followed with amphotericin B and 5-fluorocytosine, fluconazole is the highest. There was Gomori＇s methenamine silver （GMS） positive round, yeast-like and sausage-like objects found inside the histiocytes, some of which had septum. [Conclusion] Clinical manifestation of AIDS-associated Penicilliosis marneffei is complex. It mostly occurs on the patient that perpheral blood CD4^＋ lymphocyte counts less than 50 cells/uL. Definite diagnosis requires culture of the pathogenic fungus and pathology from clinical specimens. Itraconazole and amphotericin B are suggested to use in treating Penicilliosis marneffei.