马尔尼菲青霉菌的分离鉴定与耐药性分析

Isolation and drug resistance analysis of Penicillium marneffei in pediatric patients

目的分析马尔尼菲青霉菌(PMA)在无基础疾病低龄患儿的感染状况及耐药性,为马尔尼菲青霉菌病(PSM)患儿选择及时、有效的抗真菌治疗提供依据。方法收集2006年1月-2014年12月23例马尔尼菲青霉病患儿血液和骨髓标本中分离的PMA,从细菌学检验、骨髓像染色检查、组织病理学常规染色和特殊染色检查鉴定PMA,并且采用Rosoo纸片扩散法进行马尔尼菲青霉菌药物敏感性试验。结果 BACT/ALERT 3D120全自动血液培养仪提示有菌生长;糖同化试验均阳性;组织病理学常规染色显示为肉芽肿病变,中心坏死,并见典型细胞为腊肠形孢子,长形、、粗细均匀、两头钝圆、中央有一横隔;23株马尔尼菲青霉菌对5种抗真菌药物抗菌活性均较好,两性霉素B、伏立康唑、氟胞嘧啶、伊曲康唑的耐药率分别为13.0%、8.7%、4.3%、4.3%。结论马尔尼菲青霉菌已严重危害免疫力低下的低龄儿童,需严防漏检而贻误治疗时机,尤其重视降低基层医院的马尔尼菲青霉菌病的误诊率,因氟康唑敏感性高、能透过血脑屏障、不良反应小、治疗费用较低,所以在马尔尼菲青霉病患儿治疗上推荐首选药物为氟康唑。

OBJECTIVE To analyze infection status,drug resistance and drug resistance tendency of Penicillium marneffei（PMA）in young children without the underlying disease and acquire the infection rate and drug resistance characteristic of PSM,so as to choose effective antifungal therapy for them.METHODS Totally 23 cases of PSM were collected from Jan.2006 to Dec.2014.Three different detection methods including 25 ℃/37 ℃ biopolar enrichment culture test,marrow staining test,conventional and particular histopathological staining test were applied to identify PMA and Rosoo paper diffusion method was used to study the drug sensitivity of PMA in yeast phase.RESULTS BACT/ALERT 3D120 automatic blood culture system showed there were bacteria.The sugar assimilation test results were all positive.The histopathological routine staining test showed granuloma formation,central necrosis and typical cells manifested as allantospore being long and even of the body and round of the two ends with a septum transversum.A total of 23 PMA strains were isolated from clinical specimens and the antibacterial activity of the 5antifungal agents was better than others,the resistance rate of amphoteric mildew element B,voriconazole,5-fluorocytosine,itraconazole,fluconazole was 13%,8.7%,4.3%,0,0respectively,fluconazole and itraconazole were the most sensitive among them.CONCLUSION Monitoring results indicated that PMA was seriously harmful to young children with low immunity,solutions should be found to prevent the omission from delaying the treatment time,especially pay attention to reduce the rate of misdiagnosis of primary hospital of penicillium marneffei.Because of the highest susceptibility,the ability to penetrate the blood-brain barrier,the small side effect and the relative low treatment expense,the drug fluconazole was the first choice recommended for the treatment of PSM in children.