艾滋病合并马尔尼菲篮状菌病临床及药敏研究

Clinical and susceptibility study of AIDS complicated with Talaromycosis

目的通过研究艾滋病合并马尔尼菲篮状菌病患者的人口学及临床特征,以及马尔尼菲篮状菌的体外药敏试验及耐药率,为艾滋病合并马尔尼菲篮状菌病的防治提供理论依据。方法收集30例艾滋病合并马尔尼菲篮状菌病患者临床资料、临床标本,对培养阳性的标本进行体外药敏试验。分析艾滋病合并马尔尼菲篮状菌病患者临床特点、药敏实验结果、耐药情况。结果患者以青壮年男性、性接触传播、小学或初中文化,农民或无业人员为主,多数患者CD_4^+T细胞计数小于50 cells/μl,接受ART的患者CD4+T细胞平均数大于未接受ART者。马尔尼菲篮状菌对7种抗真菌药物耐药率从高到低依次为酮康唑(20.0%)、氟康唑(10.0%)、伊曲康唑(6.7%)、5-氟胞嘧啶(6.7%)、伏立康唑(3.3%)、卡泊芬净(0.0%)、两性霉素B(0.0%)。结论性活跃人群、低文化、低收入人群易患艾滋病,性接触为主要传播方式,艾滋病患者CD_4^+T细胞小于50 cells/μl时易患马尔尼菲篮状菌病。早期接受ART可促进患者免疫功能重建。艾滋病合并马尔尼菲篮状菌病患者建议首选两性霉素B、卡泊芬净进行抗真菌治疗,酮康唑、氟康唑、伊曲康唑、5-氟尿嘧啶、伏立康唑均有不同程度的耐药情况。

Objective Though the research of the clinical features and demographic characteristics of AIDS patients complicated with Talaromycosis, and the antifungal susceptibility test in vitro and drug resistance rates of Talaromyces marneffei, to provide theoretical basis for preventing and treating AIDS complicated with Talaromycosis. Methods To collect the clinical datas and clinical samples of 30 cases of AIDS complicated with Talaromycosis patients. The fungal identification for those positive specimens, and the antifungal susceptibility test in vitro were done. Then completing the analysis of these patients’ clinical features, the results of the antifungal susceptibility test and the drug resistance. Results Most of the patients were young and middle-aged men, most have primary or secondary school culture, the majority are farmers or unemployed, and most of them infected by sexual contact. The CD4^+T lymphocyte count that bellows 50 cells/μl accounted for most of these patients in the group. The CD4^+T lymphocyte counts of patients who received ART were higher than those who didn’t. The results of the drug resistance rates from high to low were as follows: ketoconazole(20.0%), fluconazole(10.0%),itraconazole(6.7%), 5-flucytosine(6.7%), voriconazole(3.3%), caspofungin(0.0%), amphotericin-B(0.0%). Conclusion Sexually active people, low-educated and low-income people are prone to HIV/AIDS, and sexual contact is the main way of transmission. Receiving ART early can promote patients’ reconstruction of immune function. AIDS complicated with Talaromycosis patients are recommended to choose amphotericin-B and caspofungin as the first choice for antifungal treatment. Ketoconazole, fluconazole, itraconazole, 5-flucytosine and voriconazole all have different drug resistances.