艾滋病合并马红球菌感染11例临床分析

Retrospective analysis of 11 cases of AIDS with Rhodococcus equi

目的分析艾滋病合并马红球菌感染的临床特征,为机会性感染的诊疗提供有力的依据。方法回顾性分析南宁市第四人民医院2014年1月-2017年12月间11例确诊为艾滋病合并马红球菌感染患者的临床特征及治疗转归。结果在本研究期间总共收治艾滋病5 785例,其中合并马红球菌感染11例。马红球菌感染确诊时患者的CD4+T淋巴细胞平均数为21个/μL。临床主要症状为咳嗽(90.9%)、发热(72.7%)、乏力(72.7%)。马红球菌培养阳性率分别为血液(81.8%)、骨髓(57.1%)、支气管灌洗液(66.7%)、胸水(80.0%)、痰液(9.1%)。肺部CT异常表现11例(100.0%),均为浸润性改变,其中多叶受累9例(81.8%),空洞8例(72.7%),胸腔积液5例(45.5%),纵膈淋巴结病变5例(45.5%),心包积液5例(45.5%)。治疗转归好转6例,放弃治疗或未治4例,死亡1例。结论马红球菌是晚期艾滋病患者中一种罕见的机会性感染,常引起败血症和空洞性肺炎,在临床上需引起重视及鉴别诊断,联合并长疗程使用抗生素是治疗成功的关键。

Objective To analyze the clinical characteristics of patients with HIV and infection caused by Rhodococcus equi, and try to provide evidence for the treatment of opportunistic infection. Methods A retrospective analysis of clinical features and outcome of 11 cases of AIDS with Rhodococcus equi infection confirmed by the Fourth People's Hospital of Nanning from January 2014 to December 2017. Results Totally 5 785 cases of AIDS were diagnosed during the period of this study, including 11 cases of Rhodococcus equi infection. At the time of diagnosis of Rhodococcus equi infection, the mean CD4+ lymphocyte counts was 21/μL. The main clinical symptoms were cough(90.9%), fever(72.7%) and fatigue(72.7%). Rhodococcus equi was most commonly isolated in blood cultures (81.8%), bone marrow (57.1%), bronchial lavage fluid (66.7%), pleural effusion (80.0%), sputum (9.1%). Chest CT finding were abnormal in 11 patients(100.0%), all of which were invasive, including 9 cases(81.8%) of multilobular involvement, 8 cases(72.7%) of cavity, 5 cases(45.5%) of pleural effusion, 5 cases (45.5%)of mediastinal lymphadenopathy and 5 cases(45.5%) of pericardial effusion. And 6 cases were cured, 4 cases were untreated, and 1 case died. Conclusion Rhodococcus equi is a rare opportunistic infection in patients with advanced AIDS, which often causes septicemia and cavitary pneumonia. It is necessary to pay attention to the diagnosis and differential diagnosis in clinic. The key to successful treatment is to combine with antibiotics for a long period of time.