肾移植后合并马尔尼菲青霉菌感染1例

One case of Penicillium marneffei infection after kidney transplantation

背景：肾移植后由于免疫抑制剂的使用及广谱抗生素的使用使移植后感染的病原菌复杂,病情严重,致死率高.因此加强对肾移植后合并罕见菌临床病原学特点的认识,及早合适的治疗是提高感染治愈率的关键.目的：观察肾移植后合并马尔尼菲青霉菌感染的临床特点与诊治.方法：文章个案分析了2010-06佛山市第一人民医院肾内科肾移植患者1例,对其临床资料,易感因素、病原学特点及治疗方案进行回顾性分析.结果与结论：患者临床表现为寒颤、高热、尿少、腹胀,咳嗽、咳痰及消瘦、疲乏.血常规白细胞（1.42～2.51）×109 L-1,血红蛋白66～83 g/L,血小板（21～43）×109 L-1,C-反应蛋白179.0～212.0 mg/L,降钙素原-u 17.2～28.9 μg/L,胸、腹水及血培养示马尔尼菲青霉菌生长,予静脉滴注伊曲康唑250 mg/d治疗,停用免疫抑制剂,并用丙种球蛋白、胸腺肽加强免疫支持,症状无好转,最后因呼吸循环衰竭,放弃治疗.肾移植后合并马尔尼菲青霉菌病临床罕见,因此临床医生对其认识不足.对于免疫功能极度低下者,出现反复发热,多脏器功能损害,需要考虑马尔尼菲青霉菌感染.做真菌双相培养,有条件做抗原测定,以便及早确诊.

BACKGROUND： Due to the application of immunosuppressants and broad-spectrum antibiotics after kidney transplantation, complicated infected pathogen emerges, illness becomes serious and death rate is high. Therefore, it is the key to improve infection cure rate by raising awareness of pathogenic characteristics of rare bacteria combined after kidney transplantation and early appropriate treatment. OBJECTIVE： To investigate the clinical characteristics and treatment of Penicillium marneffei infection after kidney transplantation. METHODS： Clinical data, predisposing factors, pathogenic characteristics and treatment of one kidney transplantation patient were analyzed retrospectively in June 2010. RESULTS AND CONCLUSION： Clinical manifestations with chills, fever, oliguria, abdominal distension, cough, sputum, weight loss and fatigue were shown in the patient. Blood routine examination： white blood cells （1.42-2.51）×109/L, hemoglobin 66-83 g/L, platelets （21-43）×109/L, C-reactive protein 179.0-212.0 mg/L, procalcitonin-u 17.2-28.9 μg/L. The growth of Penicillium marneffei was shown in the chest, ascites and blood culture. But the symptoms were not improved after 250 mg/d intravenous infusion of itraconazole, suspension of immunosuppressants and immune support with gamma globulin and thymosin. Eventually, the patient gave up the treatment because of respiratory and circulatory failure. Clinical cases of Penicillium marneffei infection after kidney transplantation are rare, so the cinician have a little understanding of it. Thus, there is in demand for a consideration to the Penicillium marneffei infection for patients who have extremely low immune function with recurrent fever and multiple organ dysfunctions. Biphasic fungal culture and antigen determination if permitted need to be done for early diagnosis.