HIV抗体阴性的马尔尼菲青霉菌病患者的易感因素及免疫状态分析

The analysis of risk factors and the immune status in Penicillium marneffei in patients without human immunodeficiency virus infection

目的对HIV阴性的马尔尼菲青霉菌病患者的易感因素及免疫状态进行分析,以提高该病的临床诊断率。方法回顾我科确诊的1例HIV阴性播散性马尔尼菲青霉菌病例特点,复习相关文献,以"马尔尼菲青霉菌"为关键词检索万方数据库、中国期刊网全文数据库,以Penicillium marneffei为关键词检索PubMed数据库,总结并分析其易感因素及可能的免疫机制。结果患者系中年男性,以间断发热、干咳、呼吸困难、多发淋巴结肿大为主要临床特点。肺部影像学示双肺弥漫性病变,外院抗结核治疗无效,我院经皮肺穿刺组织真菌培养及病理诊断为肺马尔尼菲青霉菌病。在以上数据库共检索出2 083篇文献,剔除非相关文献,以及可能重复、资料不全病例,共检索出HIV阴性者91例,其中45例有基础疾病。结论马尔尼菲青霉菌可发生在于HIV阴性,因结缔组织病、血液系统疾病、器官移植等基础疾病或与真菌免疫相关基因的突变等致使免疫功能受损的患者,与储存宿主接触史、流行区域生活或旅游、环境暴露、气候湿度等易感因素有关,对以上患者应警惕是否为马尔尼菲青霉菌感染,尽早确诊并治疗。

Objective To analyze the risk factors and the immune status in Penicilliurn marneffei ,for improving the clini- cal diagnosis.Methods A case admitted to Xiangya Hospital Central South University,diagnosed as Penicillium marneffei, was retrospectively analyzed and the related literature was reviewed.Databases including PubMed,Wanfang and Chinese Na- tional infrastructure （CNKI） were searched by using the keyword ＂Penicillium rnarneffei ＂.Then the risk factors and possible immune mechanism were summarized.Results The patient, middle-age male,was a forest worker, presented with intermit- tent fever, cough, dyspnea, emaciation, and frequent enlargement of left supraclavicular and mediastinal lymph nodes. Al- though without any underlying disease, the patient was found to have a history of contact with wild animal. Imageology showed diffuse pulmonary lesions. G, GM test were dramatically accelerated, and HIV test was negative. Anti-tuberculosis treatment was invalid.Penicillium marneffei was proved by fungal culture from percutaneous lung biopsy tissue and patho- logical diagnosis.The syptoms and imageology of the patient, after 4months of sequential treatment of Amphotericin B and itraconazole,were relieved and improved. From databases above, 91 cases of HIV-negative Penicilliurn marneffel were re- trieved.Among the cases above,45 cases were reported with underlying diseases.Conclusions Penicilliurn rnarneffei ,associ- ated with the history of contacting with reservoir host, the life or journey in epidemic region, exposure to certain environ- ment,climate and humidity,could happen in patients without HIV, while with underlying diseases, such as connective tissue diseases, hematological system disease, organ transplantation, and so on,or those happened with gene mutation, related to an- timycotie immunity.Patiens,described as before, should be alerted for their possibility of diagnose as Penicillium marneffel.The sequential treatment of Amphotericin B to itraconazole turned out to be effective.