艾滋病合并播散性马尔尼菲蓝状菌病10例临床分析

Clinical Analysis of 10 Cases of AIDS with Disseminated Marneffeinosis

目的探讨艾滋病合并播散性马尔尼菲蓝状菌病的临床表现及实验室检查的特征,分析治疗及预后,提高对本病的认识。方法回顾性分析我院2016年以来确诊的10例艾滋病合并播散性马尔尼菲蓝状菌病患者的临床资料,总结临床特点及治疗经验。结果 10例患者临床主要表现为发热,可伴咳嗽、腹痛、腹胀、腹泻、呕吐、乏力、消瘦,可有脐窝样皮疹。实验室检查可有白细胞减少、淋巴细胞减少、贫血、血小板减少,降钙素原升高,转氨酶升高,白蛋白降低;CD4+淋巴细胞计数明显减少,所有病例血培养均培养出马尔尼菲蓝状菌。胸部影像学以肺间质性病变及渗出性炎变为主。8例使用伊曲康唑抗真菌治疗,10例患者4例好转出院,4例自动出院,2例死亡。结论艾滋病合并播散性马尔尼菲蓝状菌病以发热、咳嗽、消瘦、贫血、皮疹等为主要表现,可有血细胞减少、肝功异常,多发生在CD4+淋巴细胞计数小于50个/μL的患者,伊曲康唑抗真菌治疗有效。

Objective To investigate the clinical manifestations and laboratory features of AIDS complicated with disseminated Marneffeinosis,analyze the treatment and prognosis,and improve the understanding of the disease.Methods A retrospective analysis was made on the clinical data of 10 cases of AIDS complicated with disseminated Marneffeinosis diagnosed in our hospital since 2016. The clinical characteristics and treatment experience were summarized.Results The main clinical manifestations of 10 patients were fever,accompanied by cough,abdominal pain,abdominal distension,diarrhea,vomiting,fatigue,emaciation,and umbilical fossa-like rash.Laboratory tests showed leukopenia,lymphocytopenia,anemia,thrombocytopenia,increased procalcitonin,elevated aminotransferase,and decreased albumin; The lymphocyte count of CD4＋ was significantly decreased,and all cases were cultured with Marneffy blue-form bacteria in blood culture. Chest imaging was mainly interstitial and exudative inflammation.8 cases were treated with itraconazole antifungal therapy. Among the 10 patients,4 cases were discharged,4 cases were discharged and 2 cases died.Conclusion The main manifestations of AIDS combined with disseminated Marnefferemia are fever,cough,emaciation,anemia,rashes,and so on. There can be hematopenia and abnormal liver function,most of which occur in patients whose CD4＋lymphocyte count is less than 50/μL. Itraconazole is effective in antifungal therapy.