艾滋病合并咽喉马尔尼菲青霉菌病的研究

Pharyngeal and laryngeal infection of Penicillium marneffei in patients with acquired immunodeficiency syndrome

目的研究艾滋病（AIDS）患者合并咽喉马尔尼菲青霉菌病（Penicilliosis marneffei,PSM）的咽喉表现和诊疗方法。方法收集2002年5月～2007年3月,经真菌学、血清学和组织病理学证实的5例AIDS合并咽喉PSM患者。应用抗逆转录病毒药物治疗AIDS,用两性霉素B联合氟康唑静滴治疗PSM。结果咽痛、声嘶及粘膜溃疡是AIDS合并PSM的咽喉部症状体征。5例病变组织病理学检查发现细胞内PM菌体。真菌培养分离出双相性马尔尼菲青霉菌（Penicillium marneffei,PM）。经抗真菌治疗,2例体温下降,咽喉疼痛减轻,声嘶改善,扁桃体炎症消退,溃疡面缩小,全身症状减轻。最终4例机会性感染死亡,1例仍在随访中。结论AIDS合并咽喉PSM是根据病史、临床表现和实验检查三方面作出诊断;HIV/AIDS用抗逆转录酶病毒治疗,PM用两性霉素B联合氟康唑静滴治疗。

Objective To study clinical manifestation, diagnosis and treatment of penicilliosis marneffei （ PSM ） of pharynx and larynx in acquired immunodeficiency syndrome （AIDS） patients. Methods PSM with opportunistic infection of pharynx and larynx in 5 patients with HIV/AIDS proved by mycological and histopathological examinations were collected from May 2002 to March 2007. Antiretroviral medicine for treatment of AIDS and Amphotericin B combined with fluconazole for treatment of PSM were conducted. Results Pharyngia, hoarseness and mucosal ulcers were remarkably observed. Histopathological examination found PM inside histocytes. Biphasic Penicillium marneffei （ PM ） was by mycological culture. After treatment symptoms of fever, pharyngia, hoarseness and disphagia were improved obviously in 2 patients. Ulcers in pharynx and larynx were reduced. Four patients died of opportunistic infection. Conclusion Diagnosis of PSM of infection in AIDS patients is based on clinical history manifestation and laboratory resuits. Treatment for these patients were performed with intraveneous Amphotericin B conbinated with fluconazole.