艾滋病合并败血症44例临床特点和病原菌分析

Survey of clinical features and pathogens of 44 AIDS patients complicated with septicemia

目的调查艾滋病合并败血症患者的临床特点和病原体构成。方法回顾性分析2008年1月~2011年12月收治的44例艾滋病合并败血症患者的临床资料和病原菌分布情况。结果 44例病人中,咳嗽、咳痰、发热、淋巴结肿大、贫血、低钠血症、低蛋白血症及肺部渗出性病灶多见。革兰氏阴性菌18例（40.9%）,革兰氏阳性菌7例（15.9%）,真菌19例（43.2%）。革兰氏阴性菌以沙门氏菌属多,其中猪霍乱沙门菌5例,鼠伤寒沙门菌2例;革兰氏阳性菌以葡萄球菌为主,其中金黄色葡萄球菌4例,人葡萄球菌1例;真菌以马尔尼菲青霉菌最多,共16例。治愈及好转32例,死亡12例,病死率27.3%。结论艾滋病合并败血症多发生于艾滋病晚期。临床症状复杂多样,主要致病菌为马尔尼菲青霉菌。而金黄色葡萄球菌所致败血症易导致多器官损害,病死率高。

Objective To survey the clinical features and distribution of pathogen in AIDS with septicemia. Methods The clinical data and distribution of pathogen of 44 AIDS cases with septicemia in Hengxian People ＇ Hospital from January,2008 to December,20l 1 were analyzed retrospectively. Results The 44 patients were collected including 31 with fever,28 with cough and sputum, 15 with nausea and vomit, 16 with abdominal pain, 12 with diarrhea,7 with chest pain, 8 with muscle ache,7 with anhelation ,3 with shock,23 with lymph node enlarge, 15 with hepatosplenomegaly, 19 with lung＇s rates,18 with ascites ,25 with oral leukoplakia.7 with blutpunkte or ecchymosis,lung CT of 33 cases showed infiltrates.12 with pulmonary tuberculosis, 15 with tuberculous lymphadenitis, 35 with lung bacterial infection,5 with urinary infection, 9 with virus B hepatitis, 8 with virus C hepatitis, 6 with pneumocystis organisms pneumonia, 5 with gastrointestinal bleeding, 6 with peritonitis, 4 with encephalitis. The mean CD4 cell count was 60.45 cell/tx L. The number of WBC was〈4 x 109/L or〉10 x 109/L was noticed in 20 cases,the level of hemoglobin was 〈ll0g/L observed in 32 cases,Platelet count wsa〈100 ~ 106/L in 16 cases,liver and kidney function damages were noticed in 20 cases, the level of PaO2 was 〈80mmHg in 8 cases, hyponatremia occurred to 25 cases, hypokalemia occurred to 14 cases, hypoproteinemia occurred to 33 cases. Eighteen cases infected with gram-negative bacterium （40.9%）,7 cases infected with gram-positive bacterium （15.9%）, 19 cases infected fungus（43.2% ）. Among gram-negative bacteria detected Salmonella predonimated and Penicillium marneffei was the main pathogen for fungus infection. Thirty-two cases were cured,12 died and the fatality rate was 27.3%. Conclusion Septicemia often occurred in the end stages of AIDS. Clinical features were various and complex,the most common pathogens were Penicillium marneffei. Septicemia caused by Staphylococcus anreus usually resulted in multiple organ function failures and high mortality rate.