非HIV感染播散性马尔尼菲青霉病1例

A case report of disseminated Penicilliosis Marneffei without HIV infection

目的探讨非HIV感染播散性马尔尼菲青霉病(PSM)早期诊治方法,以减少病死率。方法收集该院收治的1例非HIV感染播散性PSM患者的痰、脓液、胸腔积液、胸膜、血液、支气管灌洗液标本进行微生物培养和组织病理检查。结果脓液、支气管灌洗液和血液标本均检出马尔尼菲青霉菌,25℃呈青霉相,产生红葡萄酒色素,光镜下见典型帚状枝;37℃呈酵母相,镜下见光滑卵圆形孢子。结论该病例提示患有白癜风、糖尿病等引起免疫功能抑制者均为PSM高危人群,若出现长时间发热不退、贫血、肺部感染症状和(或)伴多发性皮肤结节或溃疡、抗生素疗效欠佳时应及时采集呼吸道、皮疹、血液、骨髓标本进行相关PSM检查,无论其是否为HIV感染者对于PSM早期诊治、预后和降低病死率均具有重要意义。

Objective To explore the early diagnosis and treatment of disseminated Penicilliosis marneffei（PSM） without human immunodeficiency virus（HIV） infection,in order to decrease the mortality.Methods Specimens,including sputum,liquor puris,pleural fluid,pleura,blood and bronchial lavage fluid,were collected from a case of patients with disseminated PSM without HIV infection and detected for microbiological culture and pathological biopsy.Results The culture of bronchial lavage fluid,liquor puris and blood were positive with Penicillium marneffei.Filamentous colonies could be cultured at 28 ℃,with classic red pigment and penicillus,and yeasty colonies could be cultured at 37 ℃,with oval,smooth and glossy spores.Conclusion This case might indicate that individual with immunosuppression,caused by vitiligo,diabetes mellitus and so on,could have high risk of PSM.All kinds of samples,including respiratory passages specimens,skin rashes,blood,bone marrow and so on,should be collected from patient with or without HIV infection,and with symptoms of long-term fever,anemia and pulmonary infection with or without multiple skin nodules,to detected PSM,which could be helpful for early diagnosis,prognosis and reducing mortality.