艾滋病合并马尔尼菲青霉菌感染中枢神经系统1例

A case of AIDS-associated Penicillium marneffei infection of the central nervous system

报道1例晚期艾滋病合并马尔尼菲青霉菌感染中枢神经系统的临床表现及治疗。患者为41岁男性,持续高效抗逆转录病毒治疗(HAART)1年余,1个月前因出现头痛症状而住院治疗。脑脊液检查提示脑压及蛋白均明显升高,并高于正常值。头颅CT提示两侧额叶低密度灶,轻度脑积水。初始考虑结核性脑膜炎,给予抗结核及甘露醇脱水降颅压治疗,疗效欠佳而自动出院。出院后脑脊液培养出马尔尼菲青霉菌。马尔尼菲青霉菌是目前发现的唯一温度依赖性双相真菌,可引起致命的系统性真菌病,以前在人类感染性疾病谱中是一个较为罕见的的病原体,但现在是东南亚地区艾滋病患者最为常见的机会性感染之一。马尔尼菲青霉菌感染最常见部位是皮肤、肺脏和内皮网状系统,包括骨髓、淋巴结、肝脏和脾脏,但中枢神经系统罕见。

The clinical manifestations and treatment of one central nervous system infected by AIDS patients with Penieillium mctrneffei were reported. A 41-year-old man with AIDS was established on highly active antiretroviral therapy for more than one year. One month ago, he represented with headache symptoms. Cerebrospinal fluid examination showed that both intracranial pressure and protein were significantly higher than normal value. CT scan revealed low density of bilateral in frontal lobe and mild hydrocephalus, consideration of tuberculous meningitis, given anti-TB and mannitol dehydration reduce intracranial pressure treatment. But the effect was poor and the patient was discharged against medical advice. Penicillium marneffei was cultured in cerebrospinal fluid after discharge.Penicillium marneffei is the only dimorphic member of the genus and can cause fatal systemic mycosis, was formerly an unusual cause of infection in humans, but now is one of the most common opportunistic infection of AIDS patients in Southeast Asia. Penicillium marneffei infection most commonly involves the skin, lungs,and reticuloendothelial system, including the bone marrow, lymph nodes, liver, and spleen, central nervous systems, but remains rare in central nervous systems.