由咽拭子发现的非HIV感染的播散性马尔尼菲青霉病的诊断与治疗

Diagnosis and treatment for disseminated Penicillium marneffei infection discovered by oropharynx swab in a non-HIV patient

目的明确诊断并治疗1例由咽拭子发现的非HIV感染的播散性马尔尼菲青霉病的罕见病例。方法收集患者咽拭子及痰液行真菌培养,采集患者肿大淋巴结行组织病理学检查,对真菌孢子DNA进行分子鉴定,同时给予两性霉素B及伊曲康唑治疗。结果咽拭子及痰液双相真菌培养均有菌落生长:25℃呈青霉相,产生红葡萄酒色素,光镜下见典型帚状枝;37℃呈酵母相,光镜下见椭圆形及腊肠形酵母样菌体。淋巴结组织PAS染色示腊肠状的菌体相互黏集呈葡萄状外观,中间有横隔。菌种分子鉴定与GenBank中马尔尼菲青霉基因完全一致。确诊为“播散性马尔尼菲青霉病”。给予两性霉素B以及伊曲康唑联合抗真菌治疗效果显著。结论对于某些原因不明发热、伴广泛肺部炎性浸润和全身淋巴结肿大的患者,在使用广谱抗生素或者正规抗结核治疗无效时,应注意作真菌学的相关检查。

Objective To diagnose and treat a rare case of disseminated Penicillium marneffei infection discovered by oropharynx swab in a non-HIV patient. Methods The patient＇ s oropharynx swab and sputum were collected for culture respectively. The lymph node was examined by histopathologic technology. Subsequently, we identified Penicillium marneffei from the culture and the tissue by polymerase chain reaction （PCR）. Finally, the patient was treated by amphotericin B and itraconazole. Results The mycological culture of the patient＇ s oropharynx swab and sputum showed that the fungus had grown in a mycelial phase at 25 ℃ , and mold-to-yeast conversion was achieved by incubating at 37 ℃. Periodic acid-Schiff stains of lymph node revealed that there were numerous round to oval thinwalled yeastlike organisms with transverse septum which had collected just like grape. Penicillium marneffei DNA was amplified by PCR technique. The patient was diagnosed as disseminated PeniciUium marneffei infection. Both amphotericin B and itraconazole were given with a definitive therapeutic effect. Conclusion As far as those patients suffer from an unknown origin fever, diffuse pulmonary inflammatory infiltration and systemic lymphadenectasis, the relative examinations of mycology should be emphasized especially under the circumstance of the failure in broad-spectrum antibiotic and regular anti-tuberculosis treatment.