25例艾滋病合并马尔尼菲篮状菌肺炎的临床分析

Clinical analysis of 25 cases of AIDS complicated with Penicillium marneffei pneumonia

目的探讨艾滋病(AIDS)合并马尔尼菲篮状菌肺炎的临床及胸部影像学特征、诊断及治疗方法。方法对25例在我院住院确诊为艾滋病合并马尔尼菲篮状菌肺炎患者的临床资料进行回顾性分析。结果25例患者中男20例,女5例,年龄28~64岁,平均(44±11)岁;病程1~12周,病程中位数4周。临床表现为发热、咳嗽、咳痰、消瘦、气促、盗汗、腹痛、腹泻、肝脾及淋巴结肿大、脐凹样皮疹等。92%的患者CD4^+T淋巴细胞<50个/μl,可表现为血液系统异常。胸部影像学表现多样,包括斑片点条状影、结节影、磨玻璃样影、空洞影、团块影、粟粒影、纵隔肺门淋巴结肿大、胸腔积液、心包积液等。84%的患者同时合并其他肺部感染性疾病。22例患者使用两性霉素B、伊曲康唑行抗真菌治疗,23例行抗艾滋病病毒治疗;最终21例患者好转,2例自动出院,2例死亡。结论艾滋病合并马尔尼菲篮状菌肺炎的临床及胸部影像学表现复杂多样,进一步掌握其临床特征有助于早期诊断及治疗,降低病死率。

Objective To investigate the clinical manifestations, chest imaging features, diagnosis and treatment of AIDS combined with Penicillium marneffei pneumonia. Method We retrospectively analyzed the clinical data of 25 patients diagnosed with AIDS combined with Penicillium marneffei pneumonia. Result Among the 25 patients, 20 were male and 5 were female, aged 28-64 years old, with an average age of (44±11) years old. The duration of disease ranged from 1 to 12 weeks, with a median duration of 4 weeks. Clinical manifestations of fever, cough, sputum, weight loss, shortness of breath, night sweats, abdominal pain, diarrhea, liver, spleen and lymph nodes, umbilical concave rash. CD4^+T lymphocytes <50 /μl were present in 92% of patients with abnormal blood system. The chest imaging features are diverse, including patch, nodules, ground glass, cavity, mass, millimeter, mediastinum hilar lymph node enlargement, pleural effusion, pericardial effusion, etc. 84% of the patients also had other pulmonary infections. Twenty-two patients received amphotericin B and itraconazole for antifungal treatment, and 23 received anti-hiv treatment.Finally, 21 patients got better, 2 were discharged automatically, and 2 died. Conclusion The clinical and chest imaging manifestations of AIDS complicated with marneffei basilar pneumonia are complex and diverse.