10例艾滋病合并马尔尼菲青霉菌病的临床分析

Clinical Analysis of 10 AIDS Patients Coinfected with Penicillium Marneffei

目的:分析艾滋病(AIDS)合并马尔尼菲青霉菌病(PM)的临床特点、治疗及结局。方法:回顾性分析10例艾滋病合并PM病人的临床特点及治疗过程。结果:10例AIDS合并PM主要临床表现为高热、皮疹、咳嗽、消瘦、贫血、肝、脾及浅表淋巴结肿大等;合并感染者多发生在免疫功能低下时;二性霉素B、伊曲康唑治疗有效;6例经积极治疗好转出院,4例死亡。结论:艾滋病合并PM感染多发生在免疫力严重低下的情况,如果不早期诊断及积极有效的抗真菌治疗,临床死亡率较高;二性霉素B、伊曲康唑均有效;骨髓穿刺找真菌孢子、血培养及骨髓培养均为有效的确诊方法。马尔尼菲青霉菌感染控制后,开始抗逆转录病毒治疗是延长HIV合并PM感染者生命有效的方法。

Objective： To analyze the clinical features,treatment and outcome of AIDS patients with Penicillinum marneffei（PM） coinfection.Methods： Ten cases of AIDS-associated PM patient＇s clinical characteristics and treatment process were retrospectively analyzed.Results： Major clinical manifestations of PM included high fever,rash,cough,weight loss,anemia,hepatomegaly,splenomegaly,and lymphadenectasis.Most cases occurred in immunocompromise.Amphotericin B or itraconazole was effective.Six patients were cured for Penicillinum marneffei by active treatment,while the other four patients died.Conclusion： Penicillum marneffei infection in immunocompromised patients is a serious disease with high mortality if the diagnosis is not made early and timely.Amphotericin B or itraconazole treatment is effective.Bone marrow puncture to find fungal spores,blood culture and bone marrow culture are simple and effective methods for the diagnosis of PM.Anti-retroviral treatment as soon as possible is the effective way to extend life of patients with HIV-PM coinfection.