AIDS合并马尔尼菲青霉病36例分析

Clinical analysis of 36 cases of AIDS with penicilliosis marneffei

目的探讨艾滋病合并马尔尼菲青霉病的临床表现,治疗与转归。方法回顾分析本院2008年8月～2009年8月收治的艾滋病合并马尔尼菲青霉36例。结果 36例艾滋病合并马尔尼菲青霉病平均年龄35.8岁。马尔尼菲青霉感染临床表现呈现非特异性,其中发热86.11%,贫血94.44%,GGT升高69.44%,AST升高63.89%,淋巴结肿大88.89%,脾大63.89%,低蛋白血症83.33%,咳嗽36.11%,皮损30.56%(其中典型改变仅5例,占13.89%),CD4+<50cells/mm388.89%,骨髓培养(27/27)及皮损活检培养(2/2)阳性率100%,血液培养阳性率69.44%(25/36)。36例经抗真菌治疗,其中29例给予HAART治疗,28例治愈,7例好转,1例死亡。结论马尔尼菲青霉是艾滋病常见的机会性感染,早发现,早治疗,长程敏感抗真菌药物联合治疗可提高治愈率,减少复发。

Objective To investigate the clinical manifestation,treatment and prognosis of AIDS with penicilliosis marneffei. Methods Thirty-six cases of AIDS with penicilliosis marneffei treated in our hospital between August 2008 to August 2009 were retrospectively analyzed. Results The average age of 36 patients of AIDS with penicilliosis marneffei was 35. 8. Clinical manifestations of Penicillium marneffei infection were non-specific,including fever （86. 11% ）,anemia （94. 44% ）,GGT increasing （69. 44% ）, AST increasing （63. 89% ）,generalized lymphadenopathy （88. 89% ）,splenomegaly （63. 89% ）,hypoproteinemia （83. 33% ）, cough （36. 11% ）,cutaneous manifestations （30. 56% ） （typical changes,13. 89% ）,CD4 ＋ 50 cells/mm3（88. 89% ）. Bone marrow aspirates culture （27 /27） and skin lesions biopsy specimen culture was 100% positive,while blood culture rate was 69. 44% （25/36）. Thirty-six patients received antifungal therapy,of which 29 patients were treated by HAART therapy with 28 cases cured, 7 cases improved,1 dead with MOF. Conclusions Penicillium marneffei is a common opportunistic pathogen of AIDS. Early detection,early treatment and long-range-sensitive antifungal combination therapy may helpful for cure rate improvement and recurrence reduction.