在北方诊治的艾滋病合并马尔尼菲青霉菌病27例临床观察

The observations of 27 AIDS cases complicated with Penicilliosis Marneffei in north China

目的总结艾滋病(AIDS)合并马尔尼菲青霉菌病的临床特点及治疗转归情况。方法回顾性资料分析。结果 2006年2月-2011年2月,北京地坛医院感染中心确诊27例艾滋病合并马尔尼菲青霉菌病患者。临床表现以发热、咳嗽、盗汗、贫血、皮疹、腹痛、多部位淋巴结肿大为主;皮疹具有特征性,皮肤活检、血培养阳性率高;胸片或胸部CT主要表现为肺野斑片状或斑点状浸润阴影、弥漫粟粒样结节改变。患者的CD4+淋巴细胞计数均<100个/μL。3例痊愈出院,22例好转出院,2例死亡。结论马尔尼菲青霉菌病是我国南方常见的艾滋病机会性感染之一,但近年在北方就诊的患者中也并不少见。确诊需多次血培养及皮肤等部位的活检,该病易误诊为肺结核和淋巴结核,治疗上单独使用伊曲康唑也可达到满意疗效。

Objective To explore the epidemiological and clinical features of Penicillium Mameffei（PM）infection in Acquired Immunodeficiency Syndrome（AIDS） patients and therapeutic effect of them in north China.Methods Twenty-seven AIDS cases complicated with Penicilliosis Mameffei（PSM）admitted between February 2006 and February 2011 were retrospectively analyzed.Results PM infection was non-specific and mostly involved multiple organs with clinical manifestations including fever,cough,night sweat,anemia,skin rashes,stomachache and lymphadenectasis.Skin rashes were specifically helpful for diagnosing PM.PM was isolated most frequently from skin biopsies culture.X-ray and CT check for patients on chest showed mostly that increasing of lung markings,shadow of slabby or smear,filling with granulations and changing of mesenchymal.Pathological changes outside of lung were lymphadenectasis of hilum of lung or mediastinal,lymphoglandulae coeliacae.All of patients was CD＋4 〈 100 cells/mm3.Three patients were cured,and 22 patients got better,the other 2 patients died.Conclusions PM has become one of the primary pathogens causing opportunistic infections in AIDS patients in south China,which was common in north China recently.The dignose needs many times culture with blood or skin biopsy.Diagnostic errors of PM were pulmonary tuberculosis or scrofula.The curative effect on treatment with itraconazole was the same as amphoteriein B.