HIV感染患者口咽、鼻腔内真菌分离率的调查

The survey of oropharyngeal and nasal fungal isolation rate in HIV-infected patients

目的了解HIV感染者口咽及鼻腔内真菌分离阳性率。方法用无菌拭子采集口咽腔溃疡、白斑、口角炎等和咽颊区黏膜分泌物,鼻腔取下鼻甲黏膜或中鼻道黏膜分泌物,直接接种于1 mL沙堡弱液体培养基中。取该离心沉淀物作真菌直接镜检,并接种于科玛嘉念珠菌显色培养基置37℃培养48 h后鉴定。如为丝状真菌,转种于察氏琼脂。25℃培养1周后根据菌落形态结合镜下结构鉴定菌种。结果 94例HIV感染者在口咽腔中真菌培养阳性62例(66%),分离出65株真菌,在鼻腔中真菌培养阳性48例(51%),分离出57株真菌。结论 HIV感染者免疫功能低下,易继发真菌机会性感染,口咽及鼻腔真菌的高寄居率是HIV侵袭性真菌感染的先兆症状,真菌菌种以白念珠菌比例为最高,口咽及鼻腔分别61%和33%。

Objective To investigate fungal positive isolating rate of oropharynx and nasal cavity of HIV infected patients. Methods Collected mucous membrane secretions of pharyngo-oral cavity ulcer, leukoplakia, angular cheilitis, pharynx-buccal region and concha nasalis inferior or middle nasal meatus of nasal cavity were inoculated into 1 mL SDA liquid medium directly. The centrifugated deposi- tions were observed directly under microscopy and inoculated into CHROM agar in 37℃ for 48 h. The isolate might be inoculated into Czapek agar medium in 25℃ for 1 week if it was filamentous, then identified into species by colony morphology and structures observed under microscopy. Results Among 94 HIV infected patients, there were 62 patients （66%） who were positive for fungal culture of pharyngo-oral cavity and 65 strains were isolated. While for nasal cavity, 48 patients （51%） were positive and 57 strains were ob- tained. Conclusions HIV infected patients were immunocompromised and easy to get secondary fungus infection. The high fungal col- onization rate in oropharynx and nasal cavity were precursory symptom of invasive fungal infection. The isolation ratio of Candida albicans were the highest, 61% and 33% for oropharynx and nasal cavity repectively.