非结核分枝杆菌肺病合并马尔尼菲蓝状菌病3例临床分析

Clinical Analysis of Three Cases of Pulmonary Disease with Non-tuberculous Mycobacterium Tuberculosis Complicated with Talaromyces Marneffei

【目的】分析非结核分枝杆菌(NTM)肺病合并马尔尼菲蓝状菌病的临床表现、影像学特征,病理表现及相关治疗【方法】回顾性分析广州市胸科医院2017年1月至2018年6月诊治的3例NTM肺病合并马尔尼菲蓝状菌病的临床资料。【结论】3例NTM肺病合并马尔尼菲蓝状菌病患者1例为男性,2例为女性,年龄50?60岁,均有咳嗽、咳痰、淋巴结肿大破溃症状,其中2例有反复血痰,2例合并皮肤软组织脓肿溃烂,2例出现严重感染、呼吸衰竭需转入ICU治疗。3例患者痰或支气管灌洗液培养确诊为NTM肺病(2例鸟分枝杆菌、1例胞内分枝杆菌),2例合并皮肤软组织脓肿并溃烂,脓液培养有马尔尼菲蓝状菌生长,1例血培养有马尔尼菲蓝状菌生长。3例患者均为非艾滋病患者,T淋巴细胞大致正常。3例患者确诊NTM肺病,抗感染治疗后症状改善不明显,最后确诊为马尔尼菲蓝状菌病,给予抗真菌治疗(1例伏立康哇,2例两性霉素B)后症状改善。【结论】NTM肺病合并马尔尼菲蓝状菌病在临床上较为少见,临床上对于反复出现发作皮肤软组织脓肿溃烂及淋巴结肿大破溃症状、常规治疗不能控制的NTM肺病病例,应考虑有合并马尔尼菲蓝状菌病的可能性。

[Objective] To analyze the clinical features .characteristics of imaging , pathogenic manifestations and re lated treatment of the non-tuberculous mycobaeteria( NTM) pulmonary disease with Talaromyces marneffei.[ Methods ] The clinical data of 3 patients with NTM with Talaromyces marneffei admitted to Guangzhou Check Hospital from January 2017to June 2018 were retrospectively analyzed.[Results]Of 3 patients.l was male and 2 were female. All were 50 -60 years old. All 3 patients had cough? sputum, and lymph node enlargement with ulceration. Among 3 patients, 2 had repeated bloody sputum.2 had skin and soft tissue abscess with ulceration.and 2 had severe lung infection and respiratory failure which needed transferred to ICU treatment. Three patients with sputum or bronchial lavage fluid were diagnosed as NTM by mycobacterium culture of sputum(2 cases of Mycobacterium avium, 1 case of Mycobaeterium intracelhlare). In addition. 2 cases with skin soft tissue abscess and ulceration had pus culture with Marneffei blulike bacteria growth, and 1 case had blood culture with Marneffei blue-like bacteria growth. All patients had no AIDS with normal T lymphocytes. All were diagnosed with NTM lung disease at the beginning, however, the symptomatic improvement was not obvious after anti-infection treatment. Finally, the diagnosis as lalaromyces marneffei was confirmed. And symptoms were much improved after anti-fungus infection treatment( 1 by voriconazole,2 by amphotericin B).[Conelusion] NTM lung disease combined with Talaromyces marneffei was rare in clinic practice. For the cases of conventional treatment failure NTM lung disease with recurrent skin abscess ulceration and lymph node enlargement plus ulceration, consideration should be given to the possibility of complicating Talaromyces marneffei.