非HIV感染的马尔尼菲青霉病2例报道并文献复习

Penicilliosis marneffei with non-HIV-infected: two cases report and literature review

目的探讨非HIV感染的马尔尼菲青霉病的临床特征,提高对本病的早期诊断与治疗水平。方法分析广州医科大学附属第一医院广州呼吸疾病研究所收治的2例非HIV感染的马尔尼菲青霉病患者的临床、影像、微生物和病理资料,并复习相关文献。结果例1,男,37岁,反复咳嗽、发热1个月,双肩关节疼痛伴消瘦,广谱抗生素治疗无效,左锁骨上及左腹股沟淋巴结肿大,头颅MR发现颅内及咽后脓肿,经纤维支气管镜肺活检及脓液培养确诊马尔尼菲青霉病,继发性癫痫。予两性霉素B脂质体静滴治疗后好转出院,继续予伊曲康唑口服液治疗3个月症状消失,复查胸部CT及头颅MRI病灶吸收,患者自行停药后复发,再次予两性霉素B脂质体治疗仍有效。例2,男,32岁,咳嗽、咳痰5月余,皮下肿块伴发热3月余,胸部CT示纵膈脓肿伴胸骨骨髓炎形成,抽吸脓液培养有马尔尼菲青霉生长。予两性霉素B脂质体抗真菌治疗过程中,患者继发感染性休克,弥漫性血管内凝血。结论马尔尼菲青霉病属于少见病,侵犯颅内的是国内首例报道,经纤维支气管镜肺活检和脓液培养可确诊。复发病例予两性霉素B脂质体治疗仍有效。早期诊断是提高治愈率的关键。

Objective To describe the clinical feature of penicilliosis marneffei and heighten the ratio of diagnosis and treatment.Methods Two cases of disseminated penicilliosis marneffei in immunocompetent hosts from this hospital were presented.Result Case 1：37-year old,male,was admitted because of recurrent episodes of coughing and fever for one month and developed pain in both shoulders and dizziness.An enlarged left supraclavicular and inguinal lymph node were palpated.Cranial MRI showed intracalvarium and retropharyngeal abscess.Disseminated penicilliosis marneffei with secondary seizure was diagnosed by transbrochial lung biopsy （TBLB） and pus fungal culture.The patient received a treatment with amphotericin B liposome and recovered.Case 2：32-year old,male,was admitted due to a productive cough for 5 months,subcutaneous mass with fever for 3 months.During the treatment with amphotericin B liposome intravenously patient developed septic shock and DIC.Conclusion As the first time in China,penicilliosis marneffei is reported to disseminate to central nervous system.TBLB and pus culture are useful for the the diagnosis.Amphotericin B liposome is effective for the recurrent disseminated Penicillium marneffei and early diagnosis is the key for the outcome of the patients with this treatment.