播散性马尔尼菲蓝状菌病1例及文献复习

A Case Report of Disseminated Talaromyces Marneffei Infection and Literature Review

患者男,44岁。反复发热近20个月,多发皮下结节9个月,肺、骨、淋巴结等多处病变。患者皮下结节穿刺物多次沙氏琼脂培养呈双相性,菌落25℃为菌丝相、37℃为酵母相,菌株经形态学特征及PCR扩增r DNA基因测序鉴定为马尔尼菲蓝状菌。采用ROSCO琼脂扩散法对该菌株酵母相进行体外药敏试验,对两性霉素B、伊曲康唑、氟康唑及伏立康唑均敏感。患者给予静滴伊曲康唑和两性霉素B治疗效果理想。诊断为播散性马尔尼菲蓝状菌病。

The patient was a 44-year-old male with recurrent fever for almost 20 months and subcutaneous nodules over 9 months.There were also pathological changes in the lung,bone and lymphatic nodules.The specimens from nodules were cultured on Sabouraud＇s medium（SDA）,and the colony presented two forms,the yeast-like form at 37℃ and the mycelial form at 25℃.The isolated fungus was identified as Talaromyces marneffei by morphologic characteristics and sequence analysis of the rDNA.And antifungal susceptibility tests in vitro via the ROSCO agar diffusion method（NeoSensitab,Rosco）were performed,showing the colony was sensitive to Amphotericin B,Itraconazole,Fluconazole and Voriconazole.And then the patient was treated with intravenous Itraconazole and Amphotericin B.The therapeutic was effective.This case was finally diagnosed as disseminated Talaromyces marneffei infection.